. 2019 Sep 5;9(1):99.

doi: 10.1186/s13613-019-0574-z.

Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study

A Harrois^{1

2}, J R Anstey³, F S Taccone⁴, A A Udy^{5

6}, G Citerio⁷, J Duranteau⁸, C Ichai⁹, R Badenes¹⁰, J R Prowle¹¹, A Ercole¹², M Oddo¹³, A Schneider¹³, M van der Jagt¹⁴, S Wolf¹⁵, R Helbok¹⁶, D W Nelson¹⁷, M B Skrifvars¹⁸, D J Cooper^{4

6}, R Bellomo^{3

6

19

20}; TBI Collaborative

Affiliations

¹ Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia. harroisanatole@yahoo.fr.
² Department of Anesthesia and Surgical Intensive Care, CHU de Bicetre, APHP, Université Paris Sud, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France. harroisanatole@yahoo.fr.
³ Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia.
⁴ Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
⁵ Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia.
⁶ Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.
⁷ School of Medicine and Surgery, University Milano Bicocca-Neurointensive Care, San Gerardo Hospital, ASST-Monza, Monza, Italy.
⁸ Department of Anesthesia and Surgical Intensive Care, CHU de Bicetre, APHP, Université Paris Sud, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France.
⁹ Université Côte d'Azur, Centre hospitalier Universitaire de Nice, Service de Réanimation Polyvalente, Hôpital Pasteur 2, Nice, France.
¹⁰ Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, Valencia, Spain.
¹¹ Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK.
¹² Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹³ Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Centre Hospitalier Universitaire, Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
¹⁴ Department of Intensive Care, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
¹⁵ Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹⁶ Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
¹⁷ Section for Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.
¹⁸ Division of Intensive Care, Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹⁹ Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.
²⁰ School of Medicine, University of Melbourne, Melbourne, Australia.

PMID: 31486921
PMCID: PMC6728106
DOI: 10.1186/s13613-019-0574-z

Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study

A Harrois et al. Ann Intensive Care. 2019.

. 2019 Sep 5;9(1):99.

doi: 10.1186/s13613-019-0574-z.

Authors

Affiliations

¹ Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia. harroisanatole@yahoo.fr.
² Department of Anesthesia and Surgical Intensive Care, CHU de Bicetre, APHP, Université Paris Sud, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France. harroisanatole@yahoo.fr.
³ Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia.
⁴ Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
⁵ Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia.
⁶ Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.
⁷ School of Medicine and Surgery, University Milano Bicocca-Neurointensive Care, San Gerardo Hospital, ASST-Monza, Monza, Italy.
⁸ Department of Anesthesia and Surgical Intensive Care, CHU de Bicetre, APHP, Université Paris Sud, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France.
⁹ Université Côte d'Azur, Centre hospitalier Universitaire de Nice, Service de Réanimation Polyvalente, Hôpital Pasteur 2, Nice, France.
¹⁰ Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, Valencia, Spain.
¹¹ Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK.
¹² Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹³ Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Centre Hospitalier Universitaire, Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
¹⁴ Department of Intensive Care, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
¹⁵ Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹⁶ Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
¹⁷ Section for Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.
¹⁸ Division of Intensive Care, Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹⁹ Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.
²⁰ School of Medicine, University of Melbourne, Melbourne, Australia.

PMID: 31486921
PMCID: PMC6728106
DOI: 10.1186/s13613-019-0574-z

Erratum in

Correction to: Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study.
Harrois A, Anstey JR, Taccone FS, Udy AA, Citerio G, Duranteau J, Ichai C, Badenes R, Prowle JR, Ercole A, Oddo M, Schneider A, van der Jagt M, Wolf S, Helbok R, Nelson DW, Skrifvars MB, Cooper DJ, Bellomo R; TBI Collaborative. Harrois A, et al. Ann Intensive Care. 2019 Dec 4;9(1):136. doi: 10.1186/s13613-019-0610-z. Ann Intensive Care. 2019. PMID: 31802308 Free PMC article.

Abstract

Background: In traumatic brain injury (TBI) patients desmopressin administration may induce rapid decreases in serum sodium and increase intracranial pressure (ICP).

Aim: In an international multi-centre study, we aimed to report changes in serum sodium and ICP after desmopressin administration in TBI patients.

Methods: We obtained data from 14 neurotrauma ICUs in Europe, Australia and UK for severe TBI patients (GCS ≤ 8) requiring ICP monitoring. We identified patients who received any desmopressin and recorded daily dose, 6-hourly serum sodium, and 6-hourly ICP.

Results: We studied 262 severe TBI patients. Of these, 39 patients (14.9%) received desmopressin. Median length of treatment with desmopressin was 1 [1-3] day and daily intravenous dose varied between centres from 0.125 to 10 mcg. The median hourly rate of decrease in serum sodium was low (- 0.1 [- 0.2 to 0.0] mmol/L/h) with a median period of decrease of 36 h. The proportion of 6-h periods in which the rate of natremia correction exceeded 0.5 mmol/L/h or 1 mmol/L/h was low, at 8% and 3%, respectively, and ICPs remained stable. After adjusting for IMPACT score and injury severity score, desmopressin administration was independently associated with increased 60-day mortality [HR of 1.83 (1.05-3.24) (p = 0.03)].

Conclusions: In severe TBI, desmopressin administration, potentially representing instances of diabetes insipidus is common and is independently associated with increased mortality. Desmopressin doses vary markedly among ICUs; however, the associated decrease in natremia rarely exceeds recommended rates and median ICP values remain unchanged. These findings support the notion that desmopressin therapy is safe.

Keywords: Desmopressin; Diabetes insipidus; Natremia; Sodium; Traumatic brain injury.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Natremia during ICU stay according to desmopressin administration status. Red dots = natremia at a given time in patients who received desmopressin, Red curve = average natremia over time in patients who received desmopressin. Black dots = natremia at a given time in patients who did not receive desmopressin, Black curve = average natremia of patients who did not receive desmopressin. p < 0.001 for natremia over time between patients who received desmopressin and those who did not receive desmopressin (two-way ANOVA)

**Fig. 2**
Median daily desmopressin dose in patients who received desmopressin. Boxplot represents median, quartiles and minimum/maximum values

**Fig. 3**
Intracranial pressure changes after a natremia correction rate higher than 0.5 mmol/L/h (during 6 h). The red boxplots correspond to the median ICPs and interquartile ranges at the start and at the end of the six-hour period (three patients with raised ICPs of 37, 43 and 73 mmHg at time 0 increased their ICPs up to 59, 54 and 100, respectively, 6 h after. They died early at day 2, 3 and 4, respectively, suggesting their DI was related to brain death)

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Cited by

Correction to: Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study.
Harrois A, Anstey JR, Taccone FS, Udy AA, Citerio G, Duranteau J, Ichai C, Badenes R, Prowle JR, Ercole A, Oddo M, Schneider A, van der Jagt M, Wolf S, Helbok R, Nelson DW, Skrifvars MB, Cooper DJ, Bellomo R; TBI Collaborative. Harrois A, et al. Ann Intensive Care. 2019 Dec 4;9(1):136. doi: 10.1186/s13613-019-0610-z. Ann Intensive Care. 2019. PMID: 31802308 Free PMC article.
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Akashi Y, Miki K, Kiba K, Yamamoto Y, Fujita K, Hirayama A. Akashi Y, et al. Neurourol Urodyn. 2025 Apr;44(4):736-742. doi: 10.1002/nau.70008. Epub 2025 Feb 12. Neurourol Urodyn. 2025. PMID: 39935423 Free PMC article.

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Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study

Affiliations

Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study

Authors

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