Traumatic Brain Injury Clinical Trial
Official title:
Disturbances of the Sodium and Fluid Balance in Patients With Severe Traumatic Brain Injury and Non-traumatic Subarachnoid Hemorrhage. A Systematic Observational Study
During the course of their acute illness patients with subarachnoid hemorrhage and severe
traumatic brain injury often develop disturbances in their fluid balance and electrolyte
homeostasis. These shifts are associated with worse outcome and increased morbidity.
The aim of this observational study is to systematically analyze the incidence,
characteristics, potential diagnostic markers and predisposing factors of such disturbances.
The investigators hypothesize that many disturbances cannot be classified with a standard
diagnostic approach and that variable fluid management contributes to their pathophysiology.
Patients will be closely monitored clinically and the exact fluid and electrolyte balances
will be recorded. Treatment decisions are within the bedside physicians responsibility.
Baseline fluid management is standardised. No interventions are planned. The observation
period equal the duration of ICU stay.
Background
Electrolyte disturbances and fluid shifts are common in patients with subarachnoid
hemorrhage (SAH) or traumatic brain injury (TBI). They usually have a rapid onset with
impact on morbidity (possibly mortality) and length of stay. So far the understanding of
underlying pathophysiologies and the contribution of iatrogenic influences is not fully
understood.
Only limited evidence and data on classification, management and outcome of patients exists.
Objective
To describe the incidence, characteristics and duration of sodium and fluid disturbances in
patients with SAH or TBI.
To document exact fluid and electrolyte management To evaluate predisposing factors and
potential predicting biomarkers such as natriuretic peptides, renin-aldosterone system.
Methods
Prospective systematic observational study with 50 patients in the SAH group and 50 patients
in the TBI group.
8hourly clinical assessment, blood and urin samples. Defined trigger points for additional
measurements.
Continuous fluid balance documentation Daily measurement of natriuretic peptides,
aldosterone and renin
;
Observational Model: Cohort, Time Perspective: Prospective
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