Discussion
AKI, toxicity, TBI, Chloremia
This post hoc analysis of the COBI trial evaluated the impact of a continuous infusion of HSS (20%) on renal function after moderate-to-severe TBI. No association between the continuous infusion of HSS (20%) and AKI (KDIGO stage 2 or 3) from inclusion to Day 28 was find. Creatinine levels and eGFR were also similar between the two groups. Chloremia was significantly higher in the HSS group. No difference in acid/base metabolic status was found between the two groups.Fluid therapy solutions, administered in ICU, contain different concentrations of electrolytes [In the past decade, three large RCTs compared buffered crystalloid to normal (0.9%) saline solution in various settings [On the other hand, patients enrolled in the COBI Trial received a substantial and prolonged amount of chloride in the interventional arm. To our knowledge, this is the first time that the effect of such an important chloride intake has been reported. Our results are not in line with a potential toxicity of chloride intake on kidney function. To date, there was only one large RCT comparing HSS (3%) to normal saline solution (0.9%) and the proportion of patients who required RRT [The main strength of our study is the design, as it is a randomized controlled trial. Second, this is the first study reporting the effect of the infusion of a highly concentrated solution in chloride. Third, we report the amount of chloride infused and the difference in blood chloride levels which is rarely done in other studies.Our study also has some limitations. First, this is a post hoc analysis, and this ancillary study was not planned in the original statistical analysis plan [