Vital recommendations for treatment of brain injury patients

A landmark Australian and New Zealand intensive care study has provided vital information for the treatment of patients with brain injuries.

The results of the SAFE-TBI Study, published today in the New England Journal of Medicine, confirm that the choice of resuscitation fluids affects the chances of patients with brain injury surviving.

Study leader Professor John Myburgh, from the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG) and The George Institute for International Health explains, “Patients with brain injury require resuscitation fluids to promptly restore blood flow to the brain following trauma. Until now, clinicians were uncertain which fluid to use in this situation and there was wide variation in the types of fluids used in these patients. Our study confirmed that patients resuscitated with albumin-based fluidsimmediately following brain injury, had a higher death rate than those who received saline.”

In 2004, researchers from the ANZICS CTG, The George Institute for International Health and the Australian Red Cross Blood Service published the largest study ever performed in intensive care in the New England Journal of Medicine. The study, called the SAFE Study, was prompted by earlier reports from the United Kingdom, which suggested that the administration of albumin-based fluids used for the resuscitation of critically ill patients was associated with a higher rate of death. The SAFE Study, which studied almost 7000 patients in Australia and New Zealand, concluded that the death rate was the same when patients were given either albumin-based or saline-based fluids. However, a higher death rate was seen in those patients who had brain injuries due to trauma, caused by road traffic crashes or falls, and who received albumin-based fluids.

Given the importance of these results, the SAFE Study researchers conducted a detailed analysis of the patients with brain injuries (the SAFE-TBI Study) that included determining the death rate two years after the original injury as well as an assessment of the level of disability in those who survived.

Professor Myburgh said, “Our study provides compelling new data to guide clinicians in the choice of resuscitation fluids in patients with traumatic brain injury. These results will have a major impact on clinical practice guidelines for resuscitation of these patients.”

The SAFE-TBI Study also raises an important public health issue for millions of patients with brain injuries worldwide. “Given that traumatic brain injury results in considerable death and disability in all societies, but particularly in the developing world where trauma rates are increasing, it is important for doctors to know that a patient's chances of survival can be substantially improved by the administration of a readily available and inexpensive fluid such as saline,” Professor Myburgh added.