Document Detail


Early use of terlipressin in catecholamine-resistant shock improves cerebral perfusion pressure in severe traumatic brain injury.
MedLine Citation:
PMID:  17378791     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Maintaining adequate cerebral perfusion pressure is an essential aspect in the treatment of severe acute brain injury. To accomplish this therapeutic goal vasopressors are usually required. Vasopressin is an important endogenous stress hormone and the infusion of low-dose vasopressin and terlipressin has been used to reverse severe hypotension. CASE REPORT: A 14-year-old male patient was admitted to the emergency room after a motorcycle accident. The patient had suffered severe traumatic brain injury, the Glasgow coma score (GCS) was four and there were signs of aspiration of gastric contents. Systemic inflammatory response syndrome and shock refractory to fluid management, norepinephrine and steroid replacement ensued. A terlipressin infusion, as a bolus dose of 1 mg, is associated with the ability to improve cerebral perfusion pressure with concomitant reduction of 80% of norepinephrine doses. DISCUSSION: The present report illustrates the potential benefits of terlipressin in refractory shock in a patient with severe traumatic brain injury. An increase in cerebral perfusion pressure (CPP) and a huge decrease in the dose of norepinephrine were observed. In the setting of severe brain injury associated with refractory hypotension, terlipressin may improve mean arterial pressure and cerebral perfusion pressure. CONCLUSION: In the setting of severe brain injury associated with refractory hypotension, terlipressin may have a role as a rescue therapy.
Authors:
J I F Salluh; G A R Martins; M S Santino; L V Araújo; G G Freitas; J C R Verdeal
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  51     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-23     Completed Date:  2007-07-03     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  England    
Other Details:
Languages:  eng     Pagination:  505-8     Citation Subset:  IM    
Affiliation:
Intensive Care Unit, Hospital Barra D' Or, Rio de Janiero, Brazil. jorgesalluh@yahoo.com.br
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MeSH Terms
Descriptor/Qualifier:
Accidents, Traffic
Adolescent
Blood Pressure / drug effects
Brain Injuries / complications*
Catecholamines / administration & dosage*
Cerebrovascular Circulation / drug effects*
Drug Resistance*
Fatal Outcome
Humans
Lypressin / analogs & derivatives*,  therapeutic use
Male
Motorcycles
Multiple Organ Failure / etiology
Norepinephrine / administration & dosage
Oxygen / blood
Respiratory Distress Syndrome, Adult / etiology
Severity of Illness Index
Shock / complications,  drug therapy*
Systemic Inflammatory Response Syndrome / complications
Time Factors
Vasoconstrictor Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Catecholamines; 0/Vasoconstrictor Agents; 14636-12-5/terlipressin; 50-57-7/Lypressin; 51-41-2/Norepinephrine; 7782-44-7/Oxygen
Comments/Corrections
Comment In:
Acta Anaesthesiol Scand. 2007 Aug;51(7):957   [PMID:  17635407 ]

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


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