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 language | English |
|---|---|
| Pages (from-to) | 1024-1030 |
| Number of pages | 7 |
| Journal | Journal of Trauma and Acute Care Surgery |
| Volume | 75 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 1 2013 |
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Keywords
- Catecholamines
- Cerebral perfusion pressure
- Traumatic brain injury
- Vasopressors
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
- Surgery
Cite this
Vasopressin for cerebral perfusion pressure management in patients with severe traumatic brain injury : Preliminary results of a randomized controlled trial. / Van Haren, Robert M.; Thorson, Chad M.; Ogilvie, Michael P.; Valle, Evan J.; Guarch, Gerardo A.; Jouria, Jassin A.; Busko, Alexander M.; Harris, Leo T.; Bullock, Ross; Jagid, Jonathan; Livingstone, Alan; Proctor, Kenneth G.
In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 6, 01.12.2013, p. 1024-1030.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Vasopressin for cerebral perfusion pressure management in patients with severe traumatic brain injury
T2 - Preliminary results of a randomized controlled trial
AU - Van Haren, Robert M.
AU - Thorson, Chad M.
AU - Ogilvie, Michael P.
AU - Valle, Evan J.
AU - Guarch, Gerardo A.
AU - Jouria, Jassin A.
AU - Busko, Alexander M.
AU - Harris, Leo T.
AU - Bullock, Ross
AU - Jagid, Jonathan
AU - Livingstone, Alan
AU - Proctor, Kenneth G
PY - 2013/12/1
Y1 - 2013/12/1
N2 - 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.
AB - 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.
KW - Catecholamines
KW - Cerebral perfusion pressure
KW - Traumatic brain injury
KW - Vasopressors
UR - http://www.scopus.com/inward/record.url?scp=84890043052&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84890043052&partnerID=8YFLogxK
U2 - 10.1097/TA.0b013e3182a99d48
DO - 10.1097/TA.0b013e3182a99d48
M3 - Article
C2 - 24256677
AN - SCOPUS:84890043052
VL - 75
SP - 1024
EP - 1030
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 6
ER -