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

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...

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Bibliographic Details
Published in:	The journal of trauma and acute care surgery Vol. 75; no. 6; pp. 1024 - 1030
Main Authors:	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, M Ross, Jagid, Jonathan R, Livingstone, Alan S, Proctor, Kenneth G
Format:	Journal Article
Language:	English
Published:	United States 01-12-2013
Subjects:	Adult Blood Pressure - drug effects Brain Injuries - diagnosis Brain Injuries - drug therapy Brain Injuries - physiopathology Female Follow-Up Studies Humans Injury Severity Score Intracranial Pressure - drug effects Male Prospective Studies Treatment Outcome Vasoconstrictor Agents - therapeutic use Vasopressins - therapeutic use
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Summary:	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. 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. 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 were worse in the AVP versus the CA groups (all p < 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. 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. Therapeutic study, level II.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-News-2 ObjectType-Feature-3 content type line 23
ISSN:	2163-0755 2163-0763
DOI:	10.1097/TA.0b013e3182a99d48