Abstract
ObjectiveThe efficiency of naloxone for the management of secondary brain injury after severe traumatic brain injury (sTBI) remains undefined. The aim of this study is to evaluate the current evidence regarding the clinical efficiency and safety of naloxone as a treatment for sTBI in mainland China.Methodology/Principal FindingsA systematic search of the China Biology Medicine disc (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Internet (CNKI), and Wan Fang Database was performed to identify randomized controlled trials (RCTs) of naloxone treatment for patients with sTBI in mainland China. The quality of the included trials was assessed, and the RevMan 5.1 software was employed to conduct this meta-analysis. Nineteen RCTs including 2332 patients were included in this study. The odds ratio (OR) showed statistically significant differences between the naloxone group and the control group (placebo) in terms of mortality at 18 months after treatment (OR, 0.51, 95%CI: 0.38–0.67; p<0.00001), prevalence of abnormal heart rates (OR, 0.30, 95%CI: 0.21–0.43; p<0.00001), abnormal breathing rate (OR, 0.25, 95%CI: 0.17–0.36; p<0.00001) at discharge, the level of intracranial pressure at discharge (OR, 2.00, 95%CI: 1.41–2.83; p = 0.0001), verbal or physical dysfunction rate (OR, 0.65, 95%CI: 0.43–0.98; p = 0.04), and severe disability rate (OR, 0.47, 95%CI: 0.30–0.73; p = 0.0001) at 18 months after the treatment. The mean difference (MD) showed statistically significant differences in awakening time at discharge (MD, −4.81, 95%CI: −5.49 to −4.12; p<0.00001), and GCS at 3 days (MD, 1.00, 95%CI: 0.70–1.30; p<0.00001) and 10 days (MD, 1.76, 95%CI: 1.55–1.97; p<0.00001) after treatment comparing naloxone with placebo group.Conclusions/SignificanceThis study indicated that applying naloxone in the early stage for sTBI patients might effectively reduce mortality, control intracranial pressure (ICP), and significantly improve the prognosis.
Highlights
Severe traumatic brain injury occurs mainly in the young population and results in high morbidity and mortality
Conclusions/Significance: This study indicated that applying naloxone in the early stage for Severe traumatic brain injury (sTBI) patients might effectively reduce mortality, control intracranial pressure (ICP), and significantly improve the prognosis
A systematic literatures search including the China Biology Medicine disc (CBM, 1978–2013 Oct), China Science and Technology Journal Database (VIP, 1989– 2013 Oct), China National Knowledge Internet (CNKI, 1994–2013 Oct), and Wan Fang Database (1997–2013 Oct) was performed to identify potentially relevant randomized controlled trials (RCTs) published in Chinese
Summary
Severe traumatic brain injury (sTBI) occurs mainly in the young population and results in high morbidity and mortality. The treatment strategy for sTBI has been developed significantly in the past three decades, the mortality remains high (20% to 50%), which is commonly caused by brain swelling, cerebral infarction, delayed hematomas and cerebral hernia [2, 3]. To prevent the secondary damage caused by uncontrollable intracranial hypertension, early decompressive craniotomy is a major strategy for sTBI and is widely used in China. Some clinical trials suggested that after decompressive craniectomy, cerebral vascular perfusion pressure increased rapidly, which might aggravate cerebral edema and secondary brain injury [5,6,7]. The American Trauma Foundations recommended that the ideal cerebral perfusion pressure for sTBI be between 50–70 mmHg [8]
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