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The impact of sedat...
The impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injury
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- Froese, Logan (författare)
- Univ Manitoba, Fac Engn, Biomed Engn, Winnipeg, MB, Canada.
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- Hammarlund, Emma (författare)
- Karolinska Institutet
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- Åkerlund, Cecilia A. I. (författare)
- Karolinska Univ Hosp, Dept Perioperat Med & Intens Care, Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Sect Perioperat Med & Intens Care, Stockholm, Sweden.
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- Tjerkaski, Jonathan (författare)
- Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
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- Hong, Erik (författare)
- Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
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- Lindblad, Caroline (författare)
- Karolinska Institutet,Uppsala universitet,Förvärvade hjärnskador,Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Uppsala Univ Hosp, Dept Neurosurg, Uppsala, Sweden.
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- Nelson, David W. (författare)
- Karolinska Institutet
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- Thelin, Eric P. (författare)
- Karolinska Institutet
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- Zeiler, Frederick A. (författare)
- Univ Manitoba, Fac Engn, Biomed Engn, Winnipeg, MB, Canada.;Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Univ Manitoba, Rady Fac Hlth Sci, Dept Surg, Sect Neurosurg, Winnipeg, MB, Canada.;Univ Manitoba, Rady Fac Hlth Sci, Dept Human Anat & Cell Sci, Winnipeg, MB, Canada.;Univ Manitoba, Ctr Aging, Winnipeg, MB, Canada.;Univ Cambridge, Addenbrookes Hosp, Dept Med, Div Anaesthesia, Cambridge, England.
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Karolinska Institutet Univ Manitoba, Fac Engn, Biomed Engn, Winnipeg, MB, Canada (creator_code:org_t)
- Springer, 2023
- 2023
- Engelska.
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Ingår i: Intensive Care Medicine Experimental. - : Springer. - 2197-425X. ; 11
- Relaterad länk:
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https://doi.org/10.1...
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https://uu.diva-port... (primary) (Raw object)
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- Background: The aim of this study is to evaluate the impact of commonly administered sedatives (Propofol, Alfentanil, Fentanyl, and Midazolam) and vasopressor (Dobutamine, Ephedrine, Noradrenaline and Vasopressin) agents on cerebrovascular reactivity in moderate/severe TBI patients. Cerebrovascular reactivity, as a surrogate for cerebral autoregulation was assessed using the long pressure reactivity index (LPRx). We evaluated the data in two phases, first we assessed the minute-by-minute data relationships between different dosing amounts of continuous infusion agents and physiological variables using boxplots, multiple linear regression and ANOVA. Next, we assessed the relationship between continuous/bolus infusion agents and physiological variables, assessing pre-/post- dose of medication change in physiology using a Wilcoxon signed-ranked test. Finally, we evaluated sub-groups of data for each individual dose change per medication, focusing on key physiological thresholds and demographics.Results: Of the 475 patients with an average stay of 10 days resulting in over 3000 days of recorded information 367 (77.3%) were male with a median Glasgow coma score of 7 (4-9). The results of this retrospective observational study confirmed that the infusion of most administered agents do not impact cerebrovascular reactivity, which is confirmed by the multiple linear regression components having p value > 0.05. Incremental dose changes or bolus doses in these medications in general do not lead to significant changes in cerebrovascular reactivity (confirm by Wilcoxon signed-ranked p value > 0.05 for nearly all assessed relationships). Within the sub-group analysis that separated the data based on LPRx pre-dose, a significance between pre-/post-drug change in LPRx was seen, however this may be more of a result from patient state than drug impact.Conclusions: Overall, this study indicates that commonly administered agents with incremental dosing changes have no clinically significant influence on cerebrovascular reactivity in TBI (nor do they impair cerebrovascular reactivity). Though further investigation in a larger and more diverse TBI patient population is required.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
Nyckelord
- Autoregulation
- Cerebrovascular reactivity
- Sedative drugs
- Vasopressors
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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