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. 2022 May 4;17(5):e0268013.
doi: 10.1371/journal.pone.0268013. eCollection 2022.

Early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort

Maxime Léger  1   2 , Denis Frasca  2   3 , Antoine Roquilly  4 , Philippe Seguin  5 , Raphaël Cinotti  4 , Claire Dahyot-Fizelier  3 , Karim Asehnoune  4 , Florent Le Borgne  2   6 , Thomas Gaillard  1 , Yohann Foucher  2   7 , Sigismond Lasocki  1 ; for AtlanRéa group
Affiliations

Early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort

Maxime Léger et al. PLoS One. .

Abstract

Barbiturates are proposed as a second/third line treatment for intracranial hypertension in traumatic brain injury (TBI) patients, but the literature remains uncertain regarding their benefit/risk balance. We aimed to evaluate the impact of barbiturates therapy in TBI patients with early intracranial hypertension on the intensive care unit (ICU) survival, the occurrence of ventilator-associated pneumonia (VAP), and the patient's functional status at three months. We used the French AtlanREA prospective cohort of trauma patients. Using a propensity score-based methodology (inverse probability of treatment weighting), we compared patients having received barbiturates within the first 24 hours of admission (barbiturates group) and those who did not (control group). We used cause-specific Cox models for ICU survival and risk of VAP, and logistic regression for the 3-month Glasgow Outcome Scale (GOS) evaluation. Among the 1396 patients with severe trauma, 383 had intracranial hypertension on admission and were analyzed. Among them, 96 (25.1%) received barbiturates. The early use of barbiturates was significantly associated with increased ICU mortality (HR = 1.85, 95%CI 1.03-3.33). However, barbiturates treatment was not significantly associated with VAP (HR = 1.02, 95%CI 0.75-1.41) or 3-month GOS (OR = 1.67, 95%CI 0.84-3.33). Regarding the absence of relevant clinical trials, our results suggest that each early prescription of barbiturates requires a careful assessment of the benefit/risk ratio.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of TBI patients of the AtlanREA cohort who had intracranial pressure monitoring and developed intracranial hypertension.
Fig 2
Fig 2. Cumulative incidences curves for death in intensive care unit (estimated by using the Aalen-Johansen estimator with discharge as a competing event, n = 383).
The solid line represents the cumulative incidence curve for the barbiturates group (96 patients), while the dotted line corresponds to the control group (287 patients).
Fig 3
Fig 3. Cumulative incidences curves for ventilator-associated pneumonia (VAP) in intensive care unit (estimated by using the Aalen-Johansen estimator with discharge and death as competing events, n = 376).
The solid line represents the cumulative incidence curve for the barbiturates group (95 patients), while the dotted line corresponds to the control group (291 patients).
Fig 4
Fig 4. Distribution of the 3-month Glasgow Outcome Scale score according to barbiturates treatment (n = 283).
The Glasgow outcome scale is represented from the light grey group (to the left of the bar plot) and corresponding to patients with little deficiency at three months, to the dark grey group (to the right of the bar plot) with a death status at three months.
See this image and copyright information in PMC

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