Prostacylin Treatment in Severe Traumatic Brain Injury - a microdialysis and outcome study

Abstract

verified sTBI, Glasgow Coma Score (GCS) at intubation and sedation of <or=8, age 15-70 years, a first-recorded cerebral perfusion pressure (CPP) of >or=10 mm Hg, and arrival within 24 h of trauma. All subjects received an intracranial pressure (ICP) measuring device, bilateral intracerebral microdialysis catheters, and a microdialysis catheter in the abdominal subcutaneous adipose tissue. Subjects were treated according to an ICP-targeted therapy based on the Lund concept. 48 patients (mean age of 35.5 years and a median GCS of 6 [3-8]) were included. We found no significant effect of prostacyclin (epoprostenol, Flolan) on either the lactate-pyruvate ratio (L/P) at 24 h or the brain glucose levels. There was no significant difference in clinical outcome between the two groups. The median Glasgow Outcome Score (GOS) at 3 months was 4, and mortality was 12.5%. The favorable outcome (GOS 4-5) was 52%. The initial L/P did not prognosticate for outcome. Thus our results indicate that there is no effect of PGI(2) at a dose of 0.5 ng/kg/min on brain L/P, brain glucose levels, or outcome at 3 months.

S-100B and neuron specific enolase are poor outcome predictors in severe traumatic brain injury treated by an intracranial pressure targeted therapy

“…The ICP targeted treatment protocol used in these subjects has been described thoroughly in previous publications 20 22. In short, all subjects were sedated to a comfortable level, allowing them to cough, using midazolam and fentanyl.…”

“…Severe traumatic brain injury (sTBI) has been treated in our department since the early 1990s with an intracranial pressure (ICP) guided protocol 20 21 22. These guidelines are based on the principles for treatment of sTBI published by Asgeirsson et al in 1994 23…”

Clinical evidence of inflammation driving secondary brain injury

“…81 Recently, a group in Sweden performed a randomized, placebo-controlled trial of epoprostenol, a commercially available prostacyclin, in TBI. 82 In a substudy, inflammatory mediators IL-6, IL-8, and C-reactive protein were measured in both groups. 83 The epoprostenol-treated group had significantly lower IL-6 and C-reactive protein 73 hours to 96 hours after the trauma, but there were no significant differences in outcomes among the groups (Grade 2A).…”

Prevalência de dor lombar e qualidade de vida no terceiro trimestre de gestação

“…Assessment -short version), constituído por 26 questões divididas em 4 domínios: físico (7 questões), psicológico (6 questões), relacões sociais (4 questões) e meio ambiente (9 questões) foi o terceiro instrumento utilizado (FLECK et al, 1999;KLUTHCOVSKY;KLUTHCOVSKY, 2009;OLIVECRONA et al, 2009 Para a avaliação dos dados foi utilizada a ferramenta desenvolvida por Pedroso et al (2010), a partir do software Microsoft Excel, que permite o cálculo dos escores e da estatística descritiva do instrumento WHOQOL-bref.…”