Document Detail


Prostacyclin treatment and clinical outcome in severe traumatic brain injury patients managed with an ICP-targeted therapy: a prospective study.
MedLine Citation:
PMID:  22149445     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To prospectively assess clinical outcome in patients with severe traumatic brain injury (sTBI) managed according to an ICP-targeted programme as well as additional treatment with prostacyclin.
MATERIALS AND METHODS: Inclusion criteria were GCS ≤8, age 15-70 years, first recorded cerebral perfusion pressure (CPP) > 10 mm Hg. Exclusion criteria were pregnancy, breastfeeding or penetrating brain injury. The patients were treated using the same ICP-guided protocol, with one group randomized to receive prostacyclin in a low dose (0.5 ng kg(-1 )min(-1)). The clinical outcome was prospectively assessed at 3, 6, 12, 18 and 24 months using structured interviews.
RESULTS: Forty-eight patients were included, mean age 35.5 years, median GCS 6 (3-8), 69% were multi-traumatized. Mortality at 3 months was 12.5%. Median Glasgow Outcome Scale (GOS) at all follow-up points was 4. Favourable outcome (GOS 4-5) at 3 months was 52%, at 24 months 64%. Favourable outcome increased over time. There was a statistically significant association between GOS, GCS at admission and age. Higher ICP(max) was associated with worse outcome.
CONCLUSION: With this treatment protocol, a low number of deaths and a high number of favourable outcomes in sTBI were observed. Prostacyclin in this low dose does not seem to improve the outcome. ICP(max) is a positive predictor of worse outcome. Higher GCS at admission and lower age are correlated to better outcome.
Authors:
Magnus Olivecrona; Marie Rodling-Wahlström; Silvana Naredi; Lars-Owe D Koskinen
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Brain injury     Volume:  26     ISSN:  1362-301X     ISO Abbreviation:  Brain Inj     Publication Date:  2012  
Date Detail:
Created Date:  2011-12-13     Completed Date:  2012-02-13     Revised Date:  2014-11-14    
Medline Journal Info:
Nlm Unique ID:  8710358     Medline TA:  Brain Inj     Country:  England    
Other Details:
Languages:  eng     Pagination:  67-75     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Antihypertensive Agents / administration & dosage,  therapeutic use*
Brain Injuries / complications,  drug therapy*,  physiopathology
Double-Blind Method
Drug Administration Schedule
Epoprostenol / administration & dosage,  therapeutic use*
Female
Follow-Up Studies
Glasgow Coma Scale
Humans
Intracranial Pressure / drug effects*
Male
Middle Aged
Prospective Studies
ROC Curve
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; DCR9Z582X0/Epoprostenol

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


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