Vasopressor Use and Effect on Blood Pressure After Severe Adult Traumatic Brain Injury

• Published in: Neurocritical care Vol. 15; no. 1; pp. 46 - 54
• Main Authors: Sookplung, Pimwan, Siriussawakul, Arunotai, Malakouti, Amin, Sharma, Deepak, Wang, Jin, Souter, Michael J., Chesnut, Randall M., Vavilala, Monica S.
• Format: Journal Article
• Language: English
• Published: New York Humana Press Inc 01-08-2011; Springer Nature B.V
• Subjects: Adult; Blood pressure; Blood Pressure - physiology; Brain Injuries - complications; Brain Injuries - physiopathology; Brain Injuries - therapy; Cardiac arrhythmia; Critical Care Medicine; Diabetes; Dopamine; Dopamine - therapeutic use; Female; Flow velocity; Glasgow Coma Scale; Heart Rate - physiology; Hemodynamics; Humans; Hypotension; Intensive; Internal Medicine; Intracranial Pressure - physiology; Male; Medicine; Medicine & Public Health; Mortality; Neurology; Norepinephrine - therapeutic use; Original Article; Patients; Phenylephrine - therapeutic use; Retrospective Studies; Trauma; Traumatic brain injury; Variables; Vasoconstrictor Agents - therapeutic use; Vasopressins - therapeutic use; Young Adult; Vasopressor; Norepinephrine; Traumatic brain injury; Dopamine; Cerebral perfusion pressure; Phenylephrine
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-010-9448-9

Background
We describe institutional vasopressor usage, and examine the effect of vasopressors on hemodynamics: heart rate (HR), mean arterial blood pressure (MAP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), brain tissue oxygenation (PbtO
2
), and jugular venous oximetry (SjVO
2
) in adults with severe traumatic brain injury (TBI).
Methods
We performed a retrospective analysis of 114 severely head injured patients who were admitted to the neurocritical care unit of Level 1 trauma center and who received vasopressors (phenylephrine, norepinephrine, dopamine, vasopressin or epinephrine) to increase blood pressure
Results
Phenylephrine was the most commonly used vasopressor (43%), followed by norepinephrine (30%), dopamine (22%), and vasopressin (5%). Adjusted for age, gender, injury severity score, vasopressor dose, baseline blood pressure, fluid administration, propofol sedation, and hypertonic saline infusion, phenylephrine use was associated with 8 mmHg higher mean arterial pressure (MAP) than dopamine (
P
 = 0.03), and 12 mmHg higher cerebral perfusion pressure (CPP) than norepinephrine (
P
 = 0.02) during the 3 h after vasopressor start. There was no difference in ICP between the drug groups, either at baseline or after vasopressor treatment.
Conclusions
Most severe TBI patients received phenylephrine. Patients who received phenylephrine had higher MAP and CPP than patients who received dopamine and norepinephrine, respectively.