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The University of Toronto Head Injury Treatment Study: A Prospective, Randomized Comparison of Pentobarbital and Mannitol

Published online by Cambridge University Press:  18 September 2015

Michael L. Schwartz ,
Charles H. Tator ,
David W. Rowed ,
S. Ross Reid ,
Kotoo Meguro  and
David F. Andrews
Michael L. Schwartz*
Affiliation:
the Division of Neurosurgery, Department of Surgery and the Department of Anesthesia, Sunnybrook Medical Centre, Toronto, and the Department of Preventive Medicine and Biostatistics, University of Toronto
Charles H. Tator
Affiliation:
the Division of Neurosurgery, Department of Surgery and the Department of Anesthesia, Sunnybrook Medical Centre, Toronto, and the Department of Preventive Medicine and Biostatistics, University of Toronto
David W. Rowed
Affiliation:
the Division of Neurosurgery, Department of Surgery and the Department of Anesthesia, Sunnybrook Medical Centre, Toronto, and the Department of Preventive Medicine and Biostatistics, University of Toronto
S. Ross Reid
Affiliation:
the Division of Neurosurgery, Department of Surgery and the Department of Anesthesia, Sunnybrook Medical Centre, Toronto, and the Department of Preventive Medicine and Biostatistics, University of Toronto
Kotoo Meguro
Affiliation:
the Division of Neurosurgery, Department of Surgery and the Department of Anesthesia, Sunnybrook Medical Centre, Toronto, and the Department of Preventive Medicine and Biostatistics, University of Toronto
David F. Andrews
Affiliation:
the Division of Neurosurgery, Department of Surgery and the Department of Anesthesia, Sunnybrook Medical Centre, Toronto, and the Department of Preventive Medicine and Biostatistics, University of Toronto
*
Sunnybrook Medical Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5
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Abstract

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Fifty-nine patients were treated in a prospective, randomized comparison of pentobarbital and mannitol for the control of intracranial hypertension resulting from head injury. Patients with elevated intracranial pressure (ICP) after evacuation of intracranial hematomas were randomized to one of two treatment groups; mannitol initially or pentobarbital initially, followed by the second drug as required by further elevation of ICP. Similarly, patients with raised ICP but without hematomas requiring evacuation were randomly assigned to two treatment groups in an identical paradigm.

Those with ICP elevation and no hematoma treated with pentobarbital as initial therapy had a 77% mortality compared to a 41% mortality for those with mannitol as initial treatment. Patients with evacuated hematomas had mortalities of 40% and 43% (no significant difference) for pentobarbital and mannitol respectively. In both no-hematoma and hematoma streams pentobarbital was less effective than mannitol for control of raised ICP.

Multivariate statistical analysis indicates that pentobarbital coma is not better than mannitol for the treatment of intracranial hypertension and may be harmful in no-hematoma patients with intracranial hypertension after head injury.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 11 , Issue 4 , November 1984 , pp. 434 - 440
Copyright
Copyright © Canadian Neurological Sciences Federation 1984

References

American Association for Automotive Medicine. The Abbreviated Injury Scale, 1980 revision. Morton Grove, Ill.Google Scholar
American College of Surgeons (1981) Advanced Trauma Life Support Course. Instructor Manual.Google Scholar
Armitage, P. (1975) Restricted sequential procedures. Biometrika 44: 9–26.CrossRefGoogle Scholar
Armitage, P. (1975) Sequential Medical Trials. 2nd Edition. Blackwell Publications.Google Scholar
Baker, SP. (1976) The Injury Severity Score: An update. J Trauma 16: 822–885.CrossRefGoogle ScholarPubMed
Baker, SP., ’Neill, B., Haddon, W., Long, WB. (1974) The Injury Severity Score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14: 187–196.CrossRefGoogle ScholarPubMed
Becker, DP., Miller, JD., Ward, JD., Greenberg, RP., Young, HF., Sakalas, R. (1977) The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47: 491–502.CrossRefGoogle ScholarPubMed
Bricolo, AP., Glick, RP. (1981) Barbiturate effects on acute experimental intracranial hypertension. J Neurosurg 55: 397–406.CrossRefGoogle ScholarPubMed
Clasen, RA., Pandolfi, S., Casey, D. (1974) Furosemide and pentobarbital in cryogenic cerebral injury and edema. Neurology 24: 642–648.CrossRefGoogle ScholarPubMed
Clubb, RJ., Maxwell, RE., Chou, SN. (1980) Experimental brain injury in the dog. The pharmacological effects of pentobarbital and sodium nitroprusside. J Neurosurg 52: 189–196.CrossRefGoogle ScholarPubMed
Cooper, PR., Moody, S., Clark, WK., Kirkpatrick, J., Maravilla, K., Gould, AL., Drane, W. (1979) Dexamethasone and severe head injury. A prospective double blind study. J Neurosurg 51: 307–316.CrossRefGoogle ScholarPubMed
Cox, DR. (1970) The Analysis of Binary Data. Methuen and Co Ltd, London.Google Scholar
Gennarelli, TA., Spielman, GM., Langfitt, TW., Gildenberg, PL., Harrington, T., Jane, JA., Marshall, LF., Miller, JD., Pitts, LH. (1982) Influence of the type of intracranial lesion on outcome from severe head injury. A multi-center study using a new classification system. J Neurosurg 56: 26–32.CrossRefGoogle Scholar
Gilman, AG., Goodman, LS., Gilman, A. (Eds.)(1980) The Pharmacological Basis of Therapeutics. Sixth Edition. MacMillan Publishing Co Inc, NY pp 154–157.Google Scholar
Gudeman, SK., Miller, JD., Becker, DP. (1979) Failure of high dose steroid therapy to influence intracranial pressure in patients with severe head injury. J Neurosurg 51: 301–306.CrossRefGoogle ScholarPubMed
Ishii, S. (1966) Brain swelling: Studies of structural, physiologic and biochemical alterations.Google Scholar
Caveness, WF., Walker, AE. (Eds.) In Head Injury, Conference proceedings. Philadelphia. JB Lippincott. pp 276–299.Google Scholar
Jennett, B., Snoek, J., Bond, MR., Brooks, N. (1981) Disability after severe head injury: Observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry 44: 285–293.CrossRefGoogle ScholarPubMed
Marshall, LF., Smith, RW., Shapiro, HM. (1979) The outcome with aggressive treatment in severe head injuries: Acute and chronic barbiturate administration in the management of head injury. J Neurosurg 50: 26–30.CrossRefGoogle ScholarPubMed
Michenfelder, JD. (1974) The interdependency of cerebral functional and metabolic effects following massive doses of thiopental in the dog. Anesthesiology 41: 231–236.CrossRefGoogle ScholarPubMed
Michenfelder, JD., Theye, R. (1973) Cerebral protection by thiopental during hypoxia. Anesthesiology 39: 510–517.CrossRefGoogle ScholarPubMed
Miller, JD. (1979) Barbiturates and raised intracranial pressure. Ann Neurol 6: 189–193.CrossRefGoogle ScholarPubMed
Miller, JD., Becker, DP., Ward, JD., Sullivan, HG., Adams, WE., Rosner, MJ. (1977) Significance of intracranial hypertension in severe head injury. J Neurosurg 47: 503–516.CrossRefGoogle ScholarPubMed
Rockoff, MA., Marshall, LF., Shapiro, HM. (1979) High dose barbiturate therapy in humans: A clinical review of 60 patients. Ann Neurol 6: 194–199.CrossRefGoogle ScholarPubMed
Rowed, DW., Leech, PJ., Reilly, PL., Miller, JD. (1975) Hypocapnia and intracranial volume-pressure relationship. A clinical and experimental study. Arch Neurol 32: 369–373.CrossRefGoogle ScholarPubMed
Rowed, DW., Souri, MK. (1980) Intravenous barbiturates in comatose head injuries: Late failure to control elevated intracranial pressure. Can J Neurol Sci 7: 320.Google Scholar
Shapiro, HM., Galindo, A., Wyte, SR., Harris, AB. (1973) Rapid intraoperative reduction of intracranial pressure with thiopentone. Br J Anaesth 45: 1057–1062.CrossRefGoogle ScholarPubMed
Shenkin, HA., Goluboff, B., Haft, H. (1962) The use of mannitol for the reduction of intracranial pressure in intracranial surgery. J Neurosurg 19: 897–901.CrossRefGoogle ScholarPubMed
Simeone, FA., Frazer, G., Lawner, P. (1979) Ischemic brain edema: Comparative effects of barbiturates and hypothermia. Stroke 10: 8–12.CrossRefGoogle ScholarPubMed
Spetzler, RF., Selman, WR. (1980) Risks of barbiturate therapy. J Neurosurg 53: 581.Google ScholarPubMed
Sylvester, RJ., Pinedo, HM., DePauw, M., Staquet, MJ., Buyse, ME., Renard, J., Bonnadonna, G. (1981) Quality of institutional participation in multi-center clinical trials. New Engl J Med 305: 852–855.CrossRefGoogle Scholar
Teasdale, G., Jennett, B. (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2: 81–84.CrossRefGoogle ScholarPubMed
Wise, BL., Chater, N. (1961) Effect of mannitol on cerebrospinal fluid pressure. Arch Neurol (Chicago) 4: 200–202.CrossRefGoogle ScholarPubMed
Wise, BL., Chater, N. (1962) The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebrospinal fluid pressure. J Neurosurg 19: 1038–1043.CrossRefGoogle Scholar
Wright, CS., McMurtry, RY., Hoyle, M., Pickard, J. (1983) Symposium on Trauma. 2. Preventable deaths in multiple trauma: Review of deaths at Sunnybrook Medical Centre Trauma Unit. Can J Surg 26: 20–23.Google Scholar