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Vasopressor Use and Effect on Blood Pressure After Severe Adult Traumatic Brain Injury

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Abstract

Background

We describe institutional vasopressor usage, and examine the effect of vasopressors on hemodynamics: heart rate (HR), mean arterial blood pressure (MAP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), brain tissue oxygenation (PbtO2), and jugular venous oximetry (SjVO2) in adults with severe traumatic brain injury (TBI).

Methods

We performed a retrospective analysis of 114 severely head injured patients who were admitted to the neurocritical care unit of Level 1 trauma center and who received vasopressors (phenylephrine, norepinephrine, dopamine, vasopressin or epinephrine) to increase blood pressure

Results

Phenylephrine was the most commonly used vasopressor (43%), followed by norepinephrine (30%), dopamine (22%), and vasopressin (5%). Adjusted for age, gender, injury severity score, vasopressor dose, baseline blood pressure, fluid administration, propofol sedation, and hypertonic saline infusion, phenylephrine use was associated with 8 mmHg higher mean arterial pressure (MAP) than dopamine (P = 0.03), and 12 mmHg higher cerebral perfusion pressure (CPP) than norepinephrine (P = 0.02) during the 3 h after vasopressor start. There was no difference in ICP between the drug groups, either at baseline or after vasopressor treatment.

Conclusions

Most severe TBI patients received phenylephrine. Patients who received phenylephrine had higher MAP and CPP than patients who received dopamine and norepinephrine, respectively.

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Acknowledgment

Funding

This work was funded by Departmental Sources.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA

    Pimwan Sookplung, Arunotai Siriussawakul, Amin Malakouti, Deepak Sharma, Michael J. Souter & Monica S. Vavilala

  2. Pediatrics and Neurological Surgery, University of Washington, Seattle, WA, USA

    Jin Wang & Randall M. Chesnut

  3. Harborview Injury Prevention and Research Center, Seattle, WA, USA

    Monica S. Vavilala

  4. Department of Anesthesiology and Pediatrics, Harborview Medical Center, 325 Ninth Avenue, Box 359724, Seattle, WA, 98104, USA

    Monica S. Vavilala

Authors
  1. Pimwan Sookplung
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  2. Arunotai Siriussawakul
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  3. Amin Malakouti
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  4. Deepak Sharma
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  5. Jin Wang
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  6. Michael J. Souter
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  7. Randall M. Chesnut
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  8. Monica S. Vavilala
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Corresponding author

Correspondence to Monica S. Vavilala.

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Sookplung, P., Siriussawakul, A., Malakouti, A. et al. Vasopressor Use and Effect on Blood Pressure After Severe Adult Traumatic Brain Injury. Neurocrit Care 15, 46–54 (2011). https://doi.org/10.1007/s12028-010-9448-9

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  • DOI: https://doi.org/10.1007/s12028-010-9448-9

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