Direct comparison of cerebrovascular effects of norepinephrine and dopamine in head-injured patients.

Détails

ID Serval
serval:BIB_929C02FF3F38
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Direct comparison of cerebrovascular effects of norepinephrine and dopamine in head-injured patients.
Périodique
Critical Care Medicine
Auteur(s)
Steiner L.A., Johnston A.J., Czosnyka M., Chatfield D.A., Salvador R., Coles J.P., Gupta A.K., Pickard J.D., Menon D.K.
ISSN
0090-3493
Statut éditorial
Publié
Date de publication
2004
Peer-reviewed
Oui
Volume
32
Numéro
4
Pages
1049-1054
Langue
anglais
Notes
Publication types: Clinical Trial ; Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
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.
Mots-clé
Adult, Aged, Blood Flow Velocity/drug effects, Blood Pressure/drug effects, Brain Injuries/drug therapy, Brain Injuries/ultrasonography, Cerebrovascular Circulation/drug effects, Cross-Over Studies, Dopamine/administration & dosage, Dopamine/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
Pubmed
Web of science
Création de la notice
29/12/2009 18:00
Dernière modification de la notice
03/03/2018 19:32
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