Use of vasopressors to raise cerebral perfusion pressure in head injured patients.
Cerebral ischemia due to low cerebral perfusion pressure (CPP) is the most important secondary effect of severe head injury. There is consensus regarding the maintenance of this pressure at levels above 70 mm Hg. One way to elevate CPP is by increasing mean arterial pressure (MAP). In this study, the authors attain this target by using adrenergic vasopressors investigating the effectiveness of dopamine, noradrenaline and methoxamine in 16 severe head injured patients. The results were: a) the increase of MAP effectively increased CPP without changes in intracranial pressure (ICP) and cerebral extraction of oxygen (CEO2); b) noradrenaline at a dose of 0.5 mg to 5 mg/h was effective and safe and might be considered the drug of choice; c) dopamine was not as effective at a high dose of 10 to 42.5 micrograms/kg/min; d) methoxamine given as a bolus was an effective way to control sudden decreases in MAP. It made the patients more responsive to dopamine. No important undesirable reactions occurred during the study.
Intensive Care Unit, Hospital de Clinicas, Montevideo, Uruguay.
A
A
Biestro
E
E
Barrios
J
J
Baraibar
C
C
Puppo
D
D
Lupano
M
M
Cancela
B
B
Borovich
J
J
Pouso
D000328:Adult; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D001921:Brain / Q000098:blood supply*; D002545:Brain Ischemia / Q000188:drug therapy* / Q000503:physiopathology; D004298:Dopamine / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007427:Intracranial Pressure / Q000187:drug effects / Q000502:physiology; D008297:Male; D008729:Methoxamine / Q000008:administration & dosage / Q000009:adverse effects; D009638:Norepinephrine / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects
D014662:Vasoconstrictor Agents; D008729:Methoxamine; D004298:Dopamine; D009638:Norepinephrine