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THAM for control of ICP.

F A Zeiler1, J Teitelbaum, L M Gillman

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Tromethamine (THAM) effectively reduces intracranial pressure (ICP) in neurological patients, with evidence supporting its use in traumatic brain injury (TBI) and stroke. While generally safe, further research is needed to clarify its long-term safety profile.

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Area of Science:

  • Neurosurgery
  • Critical Care Medicine
  • Pharmacology

Background:

  • Elevated intracranial pressure (ICP) is a critical concern in neurological illnesses.
  • Effective management strategies for reducing ICP are essential for improving patient outcomes.
  • Tromethamine (THAM) has been investigated for its potential role in ICP management.

Purpose of the Study:

  • To systematically review the literature on tromethamine (THAM) and its effects on intracranial pressure (ICP).
  • To evaluate THAM's impact on cerebral perfusion pressure, mean arterial pressure, patient outcomes, and adverse events.
  • To assess the strength of evidence for THAM's efficacy and safety in neurosurgical patients.

Main Methods:

  • Systematic literature search across multiple databases (MEDLINE, EMBASE, Scopus, etc.) and gray literature.
  • Inclusion of prospective studies documenting THAM administration and ICP changes in human patients.
  • Data extraction on population/treatment characteristics and adjudication of evidence strength using Oxford and GRADE methodologies.

Main Results:

  • Twelve articles (9 manuscripts, 3 meeting proceedings) involving 488 patients (263 THAM, 225 controls) were reviewed.
  • All but one study reported a decrease in ICP with THAM administration (bolus and continuous infusions).
  • No significant renal dysfunction, hepatocellular injury, or hypoglycemia were reported; trends towards improved outcomes in severe TBI patients were observed.

Conclusions:

  • Oxford level 2b, GRADE B evidence supports THAM's ICP-reducing effect in traumatic brain injury (TBI) and malignant ischemic infarct populations.
  • THAM demonstrates minimal side effects and may be beneficial for ICP reduction in specific neurological conditions.
  • Further prospective studies are warranted to fully elucidate the safety and efficacy of THAM in these patient populations.