β-Blocker Exposure in Patients With Severe Traumatic Brain Injury (TBI) and Cardiac Uncoupling

Abstract

betaB exposure was associated with reduced mortality among patients with severe TBI. Though loss of HR variability has previously been associated with an increase in mortality, betaB exposure appears to be associated with increased survival across all stratifications of cardiac uncoupling.

Possible indications of beta-blockers in the perioperative period other than prevention of cardiac ischemia

“…Although patients receiving beta-blockers had severe head injury more frequently, had lower Glasgow Coma Scale scores, and more frequently required craniotomy, beta-blocker use was an independent protective factor for mortality (odds ratio 0.54, 95% confidential interval 0.33-0.91). Other investigators have reported almost the same results [74][75][76][77]. In addition, Amory et al [72] retrospectively examined the perioperative use of beta-blockers on neurological complications in patients undergoing coronary artery bypass graft surgery and showed that the use of beta-blockers was associated with a substantial reduction in the incidence of postoperative neurological complications.…”

“…Neuroprotective effects are another possible beneficial effect of beta-blockers on the CNS [70][71][72][73][74][75][76][77]. In animal studies, Lysko et al [70] examined the neuroprotective mechanisms underlying the effects of carvedilol on cultured cerebellar neurons and on CA1 hippocampal neurons in gerbils exposed to brain ischemia.…”

“…A number of clinical studies have demonstrated betablocker exposure with reduced mortality in patients with head injury [72][73][74][75][76][77]. Inaba et al [73] retrospectively evaluated 1156 patients with isolated head injury who were admitted to the Intensive Care Unit during a 90-month period.…”

Mortality is Reduced for Heart Rate 80 to 89 After Traumatic Brain Injury

“…Most of these disabilities are a direct result of secondary injury processes following the mechanical insult that lead to the development of irreversible tissue damage to the central nervous system in the hours-to-days after the primary insult [2][3][4][5]. Several studies have identified a hyperadrenergic state [6][7][8] in severe TBI patients characterized by a surge in catecholamines, inducing hypermetabolism, tachycardia, and increased cardiac and cerebral oxygen demand [9][10][11][12]. Some authors believe that the hyperadrenergic state observed in moderate to severe TBI patients is a significant contributor to increased mortality [8].…”

Consciousness and the vegetative state: Today Articles from the workshop held in July 6, 2010 in Salerno, Italy

“…in the nuLF values) were observed in healthy controls and TBI patients The core clinical features of PSH-heart rate were correlated with, blood pressure, respiratory rate, temperature, sweating, and motor hyperactivity. Riordan et al, 2007 (46) 4,116 Reduced HRV was associated with an increase in mortality; beta B exposure appears associated with increased survival across all stratifications of cardiac uncoupling. Riordan et al, 2009 (45) 2,178 Reduced HR multiscale entropy was significantly associated with increasing mortality and is a reliable predictor of mortality in TBI patients.…”