Shock/Sepsis/Trauma/Critical CareProspective evaluation of early propranolol after traumatic brain injury
Section snippets
Background
Traumatic brain injury (TBI) is a leading cause of death among trauma patients accounting for one-third of all trauma mortalities [1]. For those patients that survive the initial trauma, there remains a large injury burden [2] and treatment goals are aimed at reducing secondary injury [3]. Maintaining adequate brain perfusion, limiting cerebral edema, and optimizing oxygen delivery are part of established treatment protocols [2]. Numerous therapeutics have been evaluated as potential treatment
Methods
A prospective, observational study on the early use of propranolol was conducted in the surgical intensive care unit (ICU) at our level I trauma center. All patients who required ICU admission immediately after TBI from May 2010–August 2013 were screened for moderate-to-severe TBI. Inclusion criteria included computed tomography evidence of TBI and ICU admission. Exclusion criteria included patients with head abbreviated injury score (AIS) = 6 or <3 and nonsurvivable injuries. Patients were
Results
Over the 40-mo period, 695 patients were admitted to the ICU with computed tomography evidence of TBI and a discharge head AIS ≥3. The initial 10 patients who received standard-of-care therapy (control) were enrolled between May 2010–March 2011 (Figure). Subsequently, 28 patients met EPAT criteria from April 2011–August 2013 and were enrolled prospectively. The two cohorts were similar when compared by gender, ED SBP, ED HR, mechanism of injury, and hospital mortality (Table 1). ED GCS was
Discussion
We evaluated the administration of beta blockers after TBI and demonstrated that early, low-dose propranolol did not increase the risk of bradycardic or hypotensive events across a wide range of TBI. In addition, although mortality was similar between cohorts, ICU and hospital LOS were lower in those patients that received early propranolol. Because of differences in injury severity score, GCS, and head AIS, improvements in LOS require additional studies before attributing this to a treatment
Conclusions
Although bradycardia and hypotensive events occur early after TBI, low-dose intravenous propranolol does not increase their number or severity. Early use of propranolol after TBI appears to be safe and may be associated with decreased ICU and hospital LOS. Additional enrollment is required to verify if EPAT improves outcomes.
Acknowledgment
Author's contributions: M.B., A.S., and E.J.L. contributed to the study conception and design. J.S.M., M.Y.H., D.M.H., G.B., and E.J.L. contributed to the acquisition of data and drafting of the article. J.S.M., D.M.H., G.B., M.Y.H., M.B., M.B.B., K.I., D.R.M., A.S., and E.J.L. contributed to the analysis and interpretation of data, literature review, and critical revision.
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Cited by (26)
Propranolol Reduces p-tau Accumulation and Improves Behavior Outcomes in a Polytrauma Murine Model
2023, Journal of Surgical ResearchCitation Excerpt :Of note, a large multi-institutional study investigating β-adrenergic blockade in trauma found that only 27% of patients received β-blockade for prophylaxis against catecholamine hyperactivity but 64% of patients received a β-blocker for hypertension.31 However, when patients are given propranolol intravenously after TBI, they have not demonstrated an increase in hypotensive or bradycardic events compared to controls.19 Of note, unlike our study, in which mice were dosed with a single dose of propranolol, human subjects in this study were dosed every 6 h for at least 48 h.
Postinjury Treatment to Mitigate the Effects of Aeromedical Evacuation After TBI in a Porcine Model
2022, Journal of Surgical ResearchCitation Excerpt :Clinically utilized medications following the physiologic insults of injury, hemorrhage, or ischemia include propranolol, allopurinol, and tranexamic acid (TXA). Multiple clinical studies have shown improvement in 30-d mortality and clinical neurological outcomes with propranolol administration following TBI.11-15 Propranolol has also been shown to decrease neuroinflammation and p-tau accumulation within the hippocampus via multiple animal models.5,16-19
Therapeutic effect of beta-blocker in patients with traumatic brain injury: A systematic review and meta-analysis
2017, Journal of Critical CareCitation Excerpt :A total of 5311 potential trials were identified in accordance with the first retrieval strategy. 13 cohort studies were identified in the final analysis after applying the screening criteria [14-18,27-34]. Altogether 15,734 patients were identified from the enrolled observational studies.
Early Beta-Blocker Utilization in Critically Ill Patients With Moderate-Severe Traumatic Brain Injury: A Retrospective Cohort Study
2024, Journal of Intensive Care Medicine
This article was an oral presentation at the 10th meeting of the Annual Academic Surgical Congress, Las Vegas, Nevada, on February 3–5, 2015.