Document Detail


Indomethacin and cerebral autoregulation in severe head injured patients: a transcranial Doppler study.
MedLine Citation:
PMID:  17195048     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the effect of indomethacin on cerebral autoregulation, systemic and cerebral haemodynamics, in severe head trauma patients. DESIGN: Prospective, controlled clinical trial, with repeated measurements. SETTINGS: A 12-bed adult general intensive care unit in a third level referral university hospital. PATIENTS: 16 severely head injured patients, 14 males, age range 17-60. INTERVENTIONS: Indomethacin was administrated as a load plus continuous infusion. Indomethacin reactivity was assessed as the estimated cerebral blood flow change elicited by the load. Dynamic and static cerebral autoregulation tests were performed before indomethacin administration, and during its infusion. MEASUREMENTS AND MAIN RESULTS: Systemic and cerebral haemodynamic changes were assessed through continuous monitoring of mean arterial pressure, transcranial Doppler cerebral blood flow velocity, intracranial pressure, cerebral perfusion pressure, and jugular venous oxygen saturation. Indomethacin loading dose was immediately followed by a cerebral blood flow median decrease of 36 or 29% (p = ns) evaluated by two different methods, by an ICP decrease and by an AVDO(2) increase from 3.52 to 6.15 mL/dL (p = 0.002). Dynamic autoregulation increased from a median of 28 to 57% (p<0.05) during indomethacin infusion; static autoregulation also increased, from a median of 72 to 89% (p = ns). CONCLUSIONS: Indomethacin decreased intracranial pressure and cerebral blood flow, and increased cerebral perfusion pressure, while maintaining tissue properties of further extracting O(2). The increase in both autoregulatory values reveals an enhancement of cerebral microvasculature reactivity under indomethacin, during hypertensive and--especially--during hypotensive situations.
Authors:
C Puppo; L Lopez; G Farina; E Caragna; L Moraes; A Iturralde; A Biestro
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article     Date:  2007-01-03
Journal Detail:
Title:  Acta neurochirurgica     Volume:  149     ISSN:  0001-6268     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-05     Completed Date:  2007-07-17     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  139-49; discussion 149     Citation Subset:  IM    
Affiliation:
Intensive Care Unit, Clinics Hospital, Universidad de la República, Montevideo, Uruguay. cpuppo@chasque.apc.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anti-Inflammatory Agents, Non-Steroidal / pharmacology*
Blood Flow Velocity / drug effects
Blood Pressure / drug effects
Brain Injuries / physiopathology*,  ultrasonography
Cerebrovascular Circulation / drug effects*
Female
Homeostasis / drug effects*
Humans
Indomethacin / pharmacology*
Intracranial Pressure / drug effects*
Male
Middle Aged
Prospective Studies
Ultrasonography, Doppler, Transcranial
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 53-86-1/Indomethacin

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


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