Effect of cerebral perfusion pressure augmentation with dopamine and norepinephrine on global and focal brain oxygenation after traumatic brain injury.

Details

Serval ID
serval:BIB_28F7D90E5DC6
Type
Article: article from journal or magazin.
Collection
Publications
Title
Effect of cerebral perfusion pressure augmentation with dopamine and norepinephrine on global and focal brain oxygenation after traumatic brain injury.
Journal
Intensive Care Medicine
Author(s)
Johnston A.J., Steiner L.A., Chatfield D.A., Coles J.P., Hutchinson P.J., Al-Rawi P.G., Menon D.K., Gupta A.K.
ISSN
0342-4642
Publication state
Published
Issued date
2004
Peer-reviewed
Oui
Volume
30
Number
5
Pages
791-797
Language
english
Notes
Publication types: Clinical Trial ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
OBJECTIVE: To compare the effects of a cerebral perfusion pressure (CPP) intervention achieved with dopamine and norepinephrine after severe head injury. DESIGN: Prospective, controlled, trial. SETTING: Neurosciences critical care unit. PATIENTS: Eleven patients with a head injury, requiring dopamine or norepinephrine infusions to support CPP. INTERVENTION: Cerebral tissue gas measurements were recorded using a multimodal sensor, and regional chemistry was assessed using microdialysis. Patients received in, randomised order, either dopamine or norepinephrine to achieve and maintain a CPP of 65 mmHg, and then, following a 30-min period of stable haemodynamics, a CPP of 85 mmHg. Data were then acquired using the second agent. Haemodynamic measurements and measurements of cerebral physiology were made during each period. MEASUREMENTS AND RESULTS: The CPP augmentation with norepinephrine, but not with dopamine, resulted in a significant reduction in arterial-venous oxygen difference (37+/-11 vs 33+/-12 ml/l) and a significant increase in brain tissue oxygen (2.6+/-1.1 vs 3.0+/-1.1 kPa). The CPP intervention did not significantly affect intracranial pressure. There were no significant differences between norepinephrine and dopamine on cerebral oxygenation or metabolism either at baseline or following a CPP intervention; however, the response to a CPP intervention with dopamine seemed to be more variable than the response achieved with norepinephrine. CONCLUSIONS: If CPP is to be raised to a level higher than 65-70 mmHg, then it is important to recognise that the response to the intervention may be unpredictable and that the vasoactive agent used may be of importance.
Keywords
Adult, Brain Injuries/drug therapy, Cardiotonic Agents/therapeutic use, Craniotomy, Cross-Over Studies, Dopamine/therapeutic use, Female, Glasgow Coma Scale, Humans, Intensive Care Units, Intracranial Pressure/drug effects, Male, Microdialysis, Middle Aged, Norepinephrine/therapeutic use, Sympathomimetics/therapeutic use
Pubmed
Web of science
Create date
29/12/2009 17:00
Last modification date
20/08/2019 13:08
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