Document Detail


Direct comparison of cerebrovascular effects of norepinephrine and dopamine in head-injured patients.
MedLine Citation:
PMID:  15071400     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To directly compare the cerebrovascular effects of norepinephrine and dopamine in patients with acute traumatic brain injury. DESIGN: Prospective randomized crossover trial. SETTING: Neurosciences critical care unit of a university hospital. PATIENTS: Ten acutely head-injured patients requiring vasoactive drugs to maintain a cerebral perfusion pressure of 65 mm Hg. INTERVENTIONS: Patients were randomized to start the protocol with either norepinephrine or dopamine. Using an infusion of the allocated drug, cerebral perfusion pressure was adjusted to 65 mm Hg. After 20 mins of data collection, cerebral perfusion pressure was increased to 75 mm Hg by increasing the infusion rate of the vasoactive agent. After 20 mins of data collection, cerebral perfusion pressure was increased to 85 mm Hg and again data were collected for 20 mins. Subsequently, the infusion rate of the vasoactive drug was reduced until a cerebral perfusion pressure of 65 mm Hg was reached and the drug was exchanged against the other agent. The protocol was then repeated. MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure and intracranial pressure were monitored and cerebral blood flow was estimated with transcranial Doppler. Norepinephrine led to predictable and significant increases in flow velocity for each step increase in cerebral perfusion pressure (57.5+/-19.9 cm x sec, 61.3+/-22.3 cm x sec, and 68.4+/-24.8 cm x sec at 65, 75, and 85 mm Hg, respectively; p <.05 for all three comparisons), but changes with dopamine were variable and inconsistent. There were no differences between absolute values of flow velocity or intracranial pressure between the two drugs at any cerebral perfusion pressure level. CONCLUSIONS: Norepinephrine may be more predictable and efficient to augment cerebral perfusion in patients with traumatic brain injury.
Authors:
Luzius A Steiner; Andrew J Johnston; Marek Czosnyka; Doris A Chatfield; Raymond Salvador; Jonathan P Coles; Arun K Gupta; John D Pickard; David K Menon
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  32     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-04-08     Completed Date:  2004-05-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1049-54     Citation Subset:  AIM; IM    
Affiliation:
Academic Neurosurgery, Addenbrooke's Hospital, Cambridge, UK. lsteiner@uhbs.ch
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Flow Velocity / drug effects
Blood Pressure / drug effects
Brain Injuries / drug therapy*,  ultrasonography
Cerebrovascular Circulation / drug effects*
Cross-Over Studies
Dopamine / administration & dosage*,  adverse effects
Female
Glasgow Coma Scale
Humans
Intensive Care*
Intracranial Pressure / drug effects
Male
Norepinephrine / administration & dosage*
Regional Blood Flow / drug effects
Sympathomimetics / administration & dosage*
Treatment Outcome
Ultrasonography, Doppler, Transcranial
Vasoconstrictor Agents / administration & dosage*
Chemical
Reg. No./Substance:
0/Sympathomimetics; 0/Vasoconstrictor Agents; 51-41-2/Norepinephrine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Protecting the myocardium: a role for the beta2 adrenergic receptor in the heart.
Next Document:  Randomized controlled trial of aerosolized prostacyclin therapy in children with acute lung injury.