Low-chloride- versus high-chloride-containing hypertonic solution for the treatment of subarachnoid hemorrhage–related complications: The ACETatE (A low ChloriE hyperTonic solution for brain Edema) randomized trial

Journal of Intensive Care

Alexander Papangelou¹  John J. Hanfelt²  Kai Singbartl³  Joao McONeil Plancher⁴  Cederic Pimentel⁴  Prem Kandiah⁴  C. L. Hall⁴  Owen Samuels⁴  Jacqueline Kraft⁴  Ofer Sadan⁴  William H. Asbury⁵  Alexander C. M. Greven⁶ 

[1] Department of Anesthesiology, Emory University Hospital and Emory University School of Medicine, 1364 Clifton Rd. NE, 30322, Atlanta, GA, USA;Department of Biostatistics and Bioinformatics, Emory University, 1364 Clifton Rd. NE, 30322, Atlanta, GA, USA;Department of Critical Care Medicine, Mayo Clinic, 5777 E Mayo Blvd, 85054, Phoenix, AZ, USA;Department of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University Hospital and Emory University School of Medicine, 1364 Clifton Rd. NE, 30322, Atlanta, GA, USA;Department of Pharmacy, Emory University Hospital, 1364 Clifton Rd. NE, 30322, Atlanta, GA, USA;School of Medicine, Emory University, 1364 Clifton Rd. NE, 30322, Atlanta, GA, USA;

关键词: Cerebral edema;    Subarachnoid hemorrhage;    Hyperosmolar therapy;    Hyperchloremia;    Acute kidney injury;    Neurocritical care;   

DOI  :  10.1186/s40560-020-00449-0

来源: Springer

【 摘 要 】

BackgroundRecent reports have demonstrated that among patients with subarachnoid hemorrhage (SAH) treated with hypertonic NaCl, resultant hyperchloremia has been associated with the development of acute kidney injury (AKI). We report a trial comparing the effect of two hypertonic solutions with different chloride contents on the resultant serum chloride concentrations in SAH patients, with a primary outcome aimed at limiting chloride elevation.MethodsA low ChloridE hyperTonic solution for brain Edema (ACETatE) trial is a single-center, double-blinded, double-dummy, randomized pilot trial comparing bolus infusions of 23.4% NaCl and 16.4% NaCl/Na-acetate for the treatment of cerebral edema in patients with SAH. Randomization occurred when patients developed hyperchloremia (serum Cl− ≥ 109 mmol/L) and required hyperosmolar treatment.ResultsWe enrolled 59 patients, of which 32 developed hyperchloremia and required hyperosmolar treatment. 15 patients were randomized to the 23.4% NaCl group, and 17 patients were randomized to the 16.4% NaCl/Na-acetate group. Although serum chloride levels increased similarly in both groups, the NaCl/Acetate group showed a significantly lower Cl− load at the end of the study period (978mEq vs. 2,464mEq, p < 0.01). Secondary outcome analysis revealed a reduced rate of AKI in the Na-acetate group (53.3% in the NaCl group vs. 11.8% in the Na-acetate group, p = 0.01). Both solutions had similar effects on ICP reduction, but NaCl/Acetate treatment had a more prominent effect on immediate post-infusion Na+ concentrations (increase of 2.2 ± 2.8 vs. 1.4 ± 2.6, (p < 0.01)). Proximal tubule renal biomarkers differed in concentration between the two groups.ConclusionsOur pilot trial showed the feasibility and safety of replacing 23.4% NaCl infusions with 16.4% NaCl/Na-acetate infusions to treat cerebral edema in patients with SAH. The degree of hyperchloremia was similar in the two groups. 16.4% NaCl/Na-acetate infusions led to lower Cl− load and AKI rates than 23.4% NaCl infusions. Further multi-center studies are needed to corroborate these results.Trial registrationclinicaltrials.gov # NCT03204955, registered on 6/28/2017

【 授权许可】

CC BY