Differential disruption of blood-brain barrier in severe traumatic brain injury.

BACKGROUND: Traumatic brain injury (TBI) is a significant cause of death and disability in young adults, but not much is known about the incidence and characteristics of blood-brain barrier (BBB) dysfunction in this group. In this proof of concept study, we sought to quantify the incidence of BBB dysfunction (defined as a cerebrospinal fluid (CSF)-plasma albumin quotient of ≥0.007) and examine the relationship between plasma and CSF levels of proteins and electrolytes, in patients with severe TBI. METHODS: We recruited 30 patients, all of whom were receiving hypertonic 20 % saline infusion for intracranial hypertension and had external ventricular drains in situ. Simultaneous CSF and blood samples were obtained. Biochemical testing was performed for sodium, osmolality, potassium, glucose, albumin, immunoglobulin-G, and total protein. RESULTS: Eleven patients (37 %) showed evidence of impairment of passive BBB function, with a CSF-plasma albumin quotient of ≥0.007. There were strong positive correlations seen among CSF-plasma albumin quotient and CSF-plasma immunoglobulin-G quotient and CSF-plasma total protein quotient (r = 0.967, P < 0.001 and r = 0.995, P < 0.001, respectively). We also found a higher maximum intracranial pressure (24 vs. 21 mmHg, P = 0.029) and a trend toward increased mortality (27 vs. 11 %, P = 0.33) in patients with BBB disruption. CONCLUSIONS: In summary, passive BBB dysfunction is common in patients with severe TBI, and may have important implications for effectiveness of osmotherapy and long-term outcomes. Also, our results suggest that the CSF-plasma total protein quotient, a measurement which is readily available, can be used instead of the CSF-plasma albumin quotient for evaluating BBB dysfunction.

Benefits and risks of using gelatin solution as a plasma expander for perioperative and critically ill patients: a meta-analysis.

This meta-analysis aimed to evaluate the benefits and risks of gelatin solutions compared to other intravenous fluids for patients in perioperative and critical care settings. Of the 66 studies identified from MEDLINE and EMBASE databases, 30 randomised controlled trials involving 2709 patients met the inclusion criteria and were subject to meta-analysis. The risk of mortality (odds ratio 1.03, 95% confidence interval 0.80 to 1.32) and amount of blood loss (weighted-mean-difference 7.56 ml, 95% confidence interval 18.75 to 33.87) were not significantly different between patients who were treated with gelatin solutions and other types of intravenous fluids. When compared to starches, gelatin solutions were associated with a lower risk of acute renal failure (odds ratio 0.43, 95% confidence interval 0.20 to 0.92; P=0.03). When gelatin solutions were compared to isotonic albumin, patients who were treated with gelatin solutions required a small, but significantly greater amount of blood transfusion (weighted-mean-difference 180 ml, 95% confidence interval 8.1 to 353.6; P=0.04). These findings suggest that using gelatin solutions is associated with a lower risk of acute renal failure compared to older starches. Using gelatin as a plasma expander appears to have no significant advantages over crystalloids or isotonic albumin on mortality and may have a slightly higher risk of requiring allogeneic blood transfusion in perioperative and critically ill patients. An adequately powered randomised controlled trial with economic analysis is needed before gelatin solution can be recommended as a routine plasma expander for patients undergoing major surgery or who are critically ill.

Fluid skills: drinking games and alcohol consumption among Australian university students.

The objective of this study was to assess participation in drinking games among Australian university students; to determine the range of games played, their context and participant motivations; and to analyse the impact of games on alcohol consumption and its adverse consequences. We used a cross-sectional survey incorporating structured interviews and a self-administered questionnaire with students between 18 and 25 years of age at the University of Western Australia. This was a qualitative assessment of drinking game typology and contexts and participant motivation. Quantitative outcomes were rate and frequency of participation in drinking games; amount and rate of alcohol consumption during games; incidence of adverse outcomes following participation. Twenty-seven interview responses and 256 questionnaire responses were analysed for qualitative and quantitative outcomes, respectively. The qualitative analysis enabled categorisation of drinking games by skill and competitive nature, with varying influence on hazardous drinking. Common reported motivations for play included boredom, social pressure and social unease. The associated heavy drinking and possible hazards were well recognised but did not affect the decision to play. In the quantitative arm, most drinkers (74%) reported having participated in a drinking game. Game players reported playing an average of four drinking games in the previous 6 months. An average of six standard drinks was consumed during the most recent game. Pressure to participate from others was reported by 60% of game participants, while 50% reported that they had placed pressure on others to participate. Half (51%) reported an adverse outcome following participation. Loss of consciousness due to drinking was experienced or witnessed by 89% of game players, of whom 63% reported that the person was put to bed, while 54% reported that the person was watched. Participation in drinking games was common, and plays an important social role in this group. Drinking games were associated commonly with binge drinking and adverse outcomes. Future harm minimisation strategies targeting this group should address the particular risks of these games.