Vasopressin for cerebral perfusion pressure management in patients with severe traumatic brain injury: Preliminary results of a randomized controlled trial

Robert M. Van Haren, Chad M. Thorson, Michael P. Ogilvie, Evan J. Valle, Gerardo A. Guarch, Jassin A. Jouria, Alexander M. Busko, Leo T. Harris, M. R. Bullock, Jonathan R. Jagid, Alan S. Livingstone, Kenneth G. Proctor

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

BACKGROUND: After traumatic brain injury (TBI), catecholamines (CAs) may be needed to maintain adequate cerebral perfusion pressure (CPP), but there are no recommended alternative vasopressor therapies. This is an interim report of the first study to test the hypothesis that arginine vasopressin (AVP) is a safe and effective alternative to CAs for the management of CPP in patients with severe TBI. METHODS: Since 2008, all TBI patients requiring intracranial pressure monitoring at this Level 1 trauma center have been eligible for a randomized trial to receive either CA or AVP if vasopressors were required to maintain CPP greater than 60 mm Hg. RESULTS: To date, 96 patients have been consented and randomized. Demographics, vital signs, and laboratory values were similar. As treated, 60 required no vasopressors and were the least severely injured group with the best outcomes. Twenty-three patients received CA (70% levophed, 22% dopamine, 9% phenylephrine) and 12 patients received AVP. The two vasopressor groups had similar demographics, but Injury Severity Score (ISS) and fluid requirements on intensive care unit Day 1 wereworse in the AVP versus the CA groups (all p G 0.05) before treatment. These differences indicate more severe injury with accompanying hemodynamic instability. Nevertheless, adverse events were not increased with AVP versus CA. Trends favored AVP versus CA, but no apparent differences were statistically significant at this interim point. There was no difference in mortality rates between CA and AVP. CONCLUSION: These preliminary results suggest that AVP is a safe and effective alternative to CA for the management of CPP after TBI and support the continued investigation and use of AVP when vasopressors are required for CPP management in TBI patients.

Original languageEnglish (US)
Pages (from-to)1024-1030
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number6
DOIs
StatePublished - Dec 1 2013

Keywords

  • Catecholamines
  • Cerebral perfusion pressure
  • Traumatic brain injury
  • Vasopressors

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

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