• Effect of Continuous Infusion of Hypertonic Saline vs Standard care on 6-month neurological outcomes in patients with traumatic brain injury The COBI Randomized Clinical Trial

    • Prophylactic continuous infusion of hypertonic saline had been shown in some studies to reduce the risk of intracranial hypertension and improve in-hospital mortality. Long-term outcome data are lacking
    • The COBI trial is an open-label, randomized control trial of moderate to severe TBI patients (GCS <12) receiving either continuous hypertonic saline (20% NaCl) initiated within the first 24 hours and maintaining for at least 48 hours or standard of care based on Brain Trauma Foundation guidelines (bolus osmotherapy included)
    • Primary outcome was 6-months Glasgow Outcome Scale – Extended (GOS-E)  dichotomized as poor (GOS-E 1 to 5) vs favorable (GOS-E 6 to 8).
    • 370 patients enrolled, with primary outcome data available for 359 patients
    • There was no difference between intervention and control group in 6-months GOS-E.
    • Intervention group had significantly higher serum sodium and serum osmolarity and had a reduction in risk of development of intracranial hypertension during the first 48 hours. 
    • Intracranial hypertension developed in a similar proportion of patients in the intervention and control groups, with evidence of rebound intracranial hypertension more prevalent in the intervention group, occurring from day 4 onward
    • Risk of adverse events was similar between the two groups with exception of risk of developing severe hypernatremia, which was higher in the intervention group


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