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Case Reports in Critical Care
Volume 2014, Article ID 139342, 4 pages
http://dx.doi.org/10.1155/2014/139342
Case Report

Early Implementation of THAM for ICP Control: Therapeutic Hypothermia Avoidance and Reduction in Hypertonics/Hyperosmotics

1Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada R3A 1R9
2Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada R3A 1R9
3Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada R3A 1R9
4Section of Neurocritical Care, Montreal Neurological Institute, McGill University, Montreal, QC, Canada H3A 2B4
5Section of Neurology, Montreal Neurological Institute, McGill University, Montreal, QC, Canada H3A 2B4

Received 3 October 2014; Accepted 18 November 2014; Published 4 December 2014

Academic Editor: Nicolas Nin

Copyright © 2014 F. A. Zeiler et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Tromethamine (THAM) has been demonstrated to reduce intracranial pressure (ICP). Early consideration for THAM may reduce the need for other measures for ICP control. Objective. To describe 4 cases of early THAM therapy for ICP control and highlight the potential to avoid TH and paralytics and achieve reduction in sedation and hypertonic/hyperosmotic agent requirements. Methods. We reviewed the charts of 4 patients treated with early THAM for ICP control. Results. We identified 2 patients with aneurysmal subarachnoid hemorrhage (SAH) and 2 with traumatic brain injury (TBI) receiving early THAM for ICP control. The mean time to initiation of THAM therapy was 1.8 days, with a mean duration of 5.3 days. In all patients, after 6 to 12 hours of THAM administration, ICP stability was achieved, with reduction in requirements for hypertonic saline and hyperosmotic agents. There was a relative reduction in mean hourly hypertonic saline requirements of 89.1%, 96.1%, 82.4%, and 97.0% for cases 1, 2, 3, and 4, respectively, comparing pre- to post-THAM administration. Mannitol, therapeutic hypothermia, and paralytics were avoided in all patients. Conclusions. Early administration of THAM for ICP control could potentially lead to the avoidance of other ICP directed therapies. Prospective studies of early THAM administration are warranted.