M. M. Treggiari, M.D., Ph.D., M.P.H., S. A. Deem, M.D., N.D. Yanez III, Ph.D.
Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in the United States. Annually, over 200,000 people are hospitalized and 50,000 die due to TBI. After the initial brain injury, additional injury (secondary injury) can occur due to brain swelling and an increase in the pressure inside the closed skull (high intracranial pressure). The use of fluids with high concentration of sodium (salt) is a common practice for severe TBI subjects because it causes water in the brain to shift from inside the brain cells to within blood vessels of the brain. This decreases brain swelling and, thereby, reduces intracranial pressure.
We hypothesize that increasing the sodium levels in the blood by removing water from the body instead of adding high quantities of salt might be better tolerated. We want to investigate if removing water from the body might allow achieving consistent, raised blood sodium levels, so that the benefits of high sodium blood levels can be achieved with fewer risks of side effects. We also hypothesize that consistently high sodium blood levels in the acute care setting will allow superior effects on the reduction of brain swelling. This approach might improve subject outcomes, while decreasing the potential for side effects related to hypertonic saline administration.
Conivaptan (Vaprisol®) is a drug used in patients with low serum sodium to promote water loss in the kidneys. This drug is FDA approved for the treatment of low blood sodium when the body's total fluid levels are normal or high. Conivaptan (Vaprisol®) has been demonstrated to increase sodium levels in a controlled fashion, while being well tolerated by a variety of subjects.
Our plan is to utilize conivaptan (Vaprisol®) to promote isolated water loss, in combination with normal (physiologic) fluid replacement to maintain a normal blood volume status.. The goal of this therapy is to raise blood sodium in a controlled fashion in subjects with severe TBI, and reduce the use of hypertonic saline infusion. We hypothesize that this therapy will maintain a stable state of high blood sodium, while decreasing the overall sodium load needed to achieve these goals.