Early use of terlipressin in catecholamine-resistant shock improves cerebral perfusion pressure in severe traumatic brain injury.
BACKGROUND
Maintaining adequate cerebral perfusion pressure is an essential aspect in the treatment of severe acute brain injury. To accomplish this therapeutic goal vasopressors are usually required. Vasopressin is an important endogenous stress hormone and the infusion of low-dose vasopressin and terlipressin has been used to reverse severe hypotension.


METHODS
A 14-year-old male patient was admitted to the emergency room after a motorcycle accident. The patient had suffered severe traumatic brain injury, the Glasgow coma score (GCS) was four and there were signs of aspiration of gastric contents. Systemic inflammatory response syndrome and shock refractory to fluid management, norepinephrine and steroid replacement ensued. A terlipressin infusion, as a bolus dose of 1 mg, is associated with the ability to improve cerebral perfusion pressure with concomitant reduction of 80% of norepinephrine doses.


CONCLUSIONS
The present report illustrates the potential benefits of terlipressin in refractory shock in a patient with severe traumatic brain injury. An increase in cerebral perfusion pressure (CPP) and a huge decrease in the dose of norepinephrine were observed. In the setting of severe brain injury associated with refractory hypotension, terlipressin may improve mean arterial pressure and cerebral perfusion pressure.


CONCLUSIONS
In the setting of severe brain injury associated with refractory hypotension, terlipressin may have a role as a rescue therapy.
Salluh
J I F
JI
Intensive Care Unit, Hospital Barra D' Or, Rio de Janiero, Brazil. jorgesalluh@yahoo.com.br
Martins
G A R
GA
Santino
M S
MS
Araújo
L V
LV
Freitas
G G
GG
Verdeal
J C R
JC
D000063:Accidents, Traffic; D000293:Adolescent; D001794:Blood Pressure / Q000187:drug effects; D001930:Brain Injuries / Q000150:complications*; D002395:Catecholamines / Q000008:administration & dosage*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004351:Drug Resistance; D017809:Fatal Outcome; D006801:Humans; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D009049:Motorcycles; D009102:Multiple Organ Failure / Q000209:etiology; D009638:Norepinephrine / Q000008:administration & dosage; D010100:Oxygen / Q000097:blood; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012720:Severity of Illness Index; D012769:Shock / Q000150:complications / Q000188:drug therapy*; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications; D000077585:Terlipressin; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D002395:Catecholamines; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D010100:Oxygen; D009638:Norepinephrine