Prophylactic barbiturate step-down infusion therapy has similar and favorable effects in elderly and non-elderly patients with severe traumatic brain injuries

With the aging population, the number of elderly patients with severe traumatic brain injury (sTBI) inevitably increases. The high mortality rate for sTBI in the elderly necessitates effective solutions. While we have previously reported the beneficial effects of a novel barbiturate therapy, a prophylactic step-down infusion of barbiturates (sdB), using thiamylal with normothermia (NOR) in patients with sTBI, its effects on elderly patients remain unclear. This study aimed to compare the efficacy and safety of sdB between elderly and non-elderly patients with sTBI.

We included 25 sTBI patients treated with sdB+NOR between January 2013 and March 2020. Patients were stratified into elderly (≥75 years, n = 8) and non-elderly (<75 years, n = 17) groups. Patient characteristics were similar between groups except for sex ratio. Outcomes compared included primary endpoints (favorable outcome at discharge and at 6–12 months), secondary endpoints (composite death at discharge and at 6–12 months), side effects, complications, intracranial pressure (ICP), cerebral perfusion pressure (CPP) control, and hospitalization period.

The hospitalization period tended to be longer in elderly patients. There were no significant differences in the incidence of side effects or complications related to sdB between the groups. Both primary (favorable outcome) and secondary (composite death) endpoints were similar at discharge and at 6-12 months for elderly and non-elderly patients. ICP and CPP were well controlled in the elderly patients.

The results suggest that sdB+NOR is as effective and safe for elderly patients with sTBI as it is for non-elderly patients.