Does vasopressin exacerbate cerebral edema in patients with severe traumatic brain injury?

Casey J. Allen, Ty Subhawong, Mena M. Hanna, Lydia Chelala, Ross Bullock, Carl I Schulman, Kenneth G Proctor

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Arginine vasopressin (AVP) is often used as an alternative pressor to catecholamines (CATs). However, unlike CATs, AVP is a powerful antidiuretic that could promote edema. We tested the hypothesis that AVP promoted cerebral edema and/or increased requirements for osmotherapy, relative to those who received CATs, for cerebral perfusion pressure (CPP) management after traumatic brain injury (TBI). This is a retrospective review of 286 consecutive TBI patients with intracranial pressure monitoring at a single institution from September 2008 to January 2015. Cerebral edema was quantitated using CT attenuation in prespecified areas of gray and white matter. Results: To maintain CPP >60 mm Hg, 205 patients required no vasopressors, 41 received a single CAT, 12 received AVP, and 28 required both. Those who required no pressors were generally less injured; required less hyperosmolar therapy and less total fluid; and had lower plasma Na, lower intracranial pressure, less edema, and lower mortality (all P < 0.05). Edema; daily mean, minimum, and maximum Na levels; and mortality were similar with AVP versus CATs, but the daily requirement of mannitol and 3 per cent NaCl were reduced by 45 and 35 per cent (both P < 0.05). In patients with TBI who required CPP therapy, AVP reduced the requirements for hyperosmolar therapy and did not delay resolution or increase cerebral edema compared with CATs.

Original languageEnglish (US)
Pages (from-to)43-50
Number of pages8
JournalAmerican Surgeon
Volume84
Issue number1
StatePublished - Jan 1 2018

Fingerprint

Arginine Vasopressin
Brain Edema
Vasopressins
Catecholamines
Cerebrovascular Circulation
Edema
Intracranial Pressure
Mortality
Mannitol
Traumatic Brain Injury
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Does vasopressin exacerbate cerebral edema in patients with severe traumatic brain injury? / Allen, Casey J.; Subhawong, Ty; Hanna, Mena M.; Chelala, Lydia; Bullock, Ross; Schulman, Carl I; Proctor, Kenneth G.

In: American Surgeon, Vol. 84, No. 1, 01.01.2018, p. 43-50.

Research output: Contribution to journalArticle

Allen, Casey J. ; Subhawong, Ty ; Hanna, Mena M. ; Chelala, Lydia ; Bullock, Ross ; Schulman, Carl I ; Proctor, Kenneth G. / Does vasopressin exacerbate cerebral edema in patients with severe traumatic brain injury?. In: American Surgeon. 2018 ; Vol. 84, No. 1. pp. 43-50.
@article{68064b19650842b3801249a1ef8607cb,
title = "Does vasopressin exacerbate cerebral edema in patients with severe traumatic brain injury?",
abstract = "Arginine vasopressin (AVP) is often used as an alternative pressor to catecholamines (CATs). However, unlike CATs, AVP is a powerful antidiuretic that could promote edema. We tested the hypothesis that AVP promoted cerebral edema and/or increased requirements for osmotherapy, relative to those who received CATs, for cerebral perfusion pressure (CPP) management after traumatic brain injury (TBI). This is a retrospective review of 286 consecutive TBI patients with intracranial pressure monitoring at a single institution from September 2008 to January 2015. Cerebral edema was quantitated using CT attenuation in prespecified areas of gray and white matter. Results: To maintain CPP >60 mm Hg, 205 patients required no vasopressors, 41 received a single CAT, 12 received AVP, and 28 required both. Those who required no pressors were generally less injured; required less hyperosmolar therapy and less total fluid; and had lower plasma Na, lower intracranial pressure, less edema, and lower mortality (all P < 0.05). Edema; daily mean, minimum, and maximum Na levels; and mortality were similar with AVP versus CATs, but the daily requirement of mannitol and 3 per cent NaCl were reduced by 45 and 35 per cent (both P < 0.05). In patients with TBI who required CPP therapy, AVP reduced the requirements for hyperosmolar therapy and did not delay resolution or increase cerebral edema compared with CATs.",
author = "Allen, {Casey J.} and Ty Subhawong and Hanna, {Mena M.} and Lydia Chelala and Ross Bullock and Schulman, {Carl I} and Proctor, {Kenneth G}",
year = "2018",
month = "1",
day = "1",
language = "English (US)",
volume = "84",
pages = "43--50",
journal = "The American surgeon",
issn = "0003-1348",
publisher = "Southeastern Surgical Congress",
number = "1",

}

TY - JOUR

T1 - Does vasopressin exacerbate cerebral edema in patients with severe traumatic brain injury?

AU - Allen, Casey J.

AU - Subhawong, Ty

AU - Hanna, Mena M.

AU - Chelala, Lydia

AU - Bullock, Ross

AU - Schulman, Carl I

AU - Proctor, Kenneth G

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Arginine vasopressin (AVP) is often used as an alternative pressor to catecholamines (CATs). However, unlike CATs, AVP is a powerful antidiuretic that could promote edema. We tested the hypothesis that AVP promoted cerebral edema and/or increased requirements for osmotherapy, relative to those who received CATs, for cerebral perfusion pressure (CPP) management after traumatic brain injury (TBI). This is a retrospective review of 286 consecutive TBI patients with intracranial pressure monitoring at a single institution from September 2008 to January 2015. Cerebral edema was quantitated using CT attenuation in prespecified areas of gray and white matter. Results: To maintain CPP >60 mm Hg, 205 patients required no vasopressors, 41 received a single CAT, 12 received AVP, and 28 required both. Those who required no pressors were generally less injured; required less hyperosmolar therapy and less total fluid; and had lower plasma Na, lower intracranial pressure, less edema, and lower mortality (all P < 0.05). Edema; daily mean, minimum, and maximum Na levels; and mortality were similar with AVP versus CATs, but the daily requirement of mannitol and 3 per cent NaCl were reduced by 45 and 35 per cent (both P < 0.05). In patients with TBI who required CPP therapy, AVP reduced the requirements for hyperosmolar therapy and did not delay resolution or increase cerebral edema compared with CATs.

AB - Arginine vasopressin (AVP) is often used as an alternative pressor to catecholamines (CATs). However, unlike CATs, AVP is a powerful antidiuretic that could promote edema. We tested the hypothesis that AVP promoted cerebral edema and/or increased requirements for osmotherapy, relative to those who received CATs, for cerebral perfusion pressure (CPP) management after traumatic brain injury (TBI). This is a retrospective review of 286 consecutive TBI patients with intracranial pressure monitoring at a single institution from September 2008 to January 2015. Cerebral edema was quantitated using CT attenuation in prespecified areas of gray and white matter. Results: To maintain CPP >60 mm Hg, 205 patients required no vasopressors, 41 received a single CAT, 12 received AVP, and 28 required both. Those who required no pressors were generally less injured; required less hyperosmolar therapy and less total fluid; and had lower plasma Na, lower intracranial pressure, less edema, and lower mortality (all P < 0.05). Edema; daily mean, minimum, and maximum Na levels; and mortality were similar with AVP versus CATs, but the daily requirement of mannitol and 3 per cent NaCl were reduced by 45 and 35 per cent (both P < 0.05). In patients with TBI who required CPP therapy, AVP reduced the requirements for hyperosmolar therapy and did not delay resolution or increase cerebral edema compared with CATs.

UR - http://www.scopus.com/inward/record.url?scp=85041945879&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041945879&partnerID=8YFLogxK

M3 - Article

C2 - 29428027

AN - SCOPUS:85041945879

VL - 84

SP - 43

EP - 50

JO - The American surgeon

JF - The American surgeon

SN - 0003-1348

IS - 1

ER -