Research Reports - Naloxone for severe traumatic brain injury

PLoS One. 2014 Dec 19;9(12)

Zhang H(1), Wang X(1), Li Y(1), Du R(2), Xu E(3), Dong L(1), Wang X(1), Yan Z(1), Pang L(1), Wei M(1), She L(1)

OBJECTIVE: The 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 FINDINGS: A 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
CONCLUSIONS/SIGNIFICANCE: This 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.

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