Prostacyclin treatment in severe traumatic brain injury: a microdialysis and outcome study.
Prostacyclin (PGI(2)) is a potent vasodilator, inhibitor of leukocyte adhesion, and platelet aggregation. In trauma the balance between PGI(2) and thromboxane A(2) (TXA(2)) is shifted towards TXA(2). Externally provided PGI(2) would, from a theoretical and experimental point of view, improve the microcirculation in injured brain tissue. This study is a prospective consecutive double-blinded randomized study on the effect of PGI(2) versus placebo in severe traumatic brain injury (sTBI). All patients with sTBI were eligible.


METHODS
verified sTBI, Glasgow Coma Score (GCS) at intubation and sedation of <or=8, age 15-70 years, a first-recorded cerebral perfusion pressure (CPP) of >or=10 mm Hg, and arrival within 24 h of trauma. All subjects received an intracranial pressure (ICP) measuring device, bilateral intracerebral microdialysis catheters, and a microdialysis catheter in the abdominal subcutaneous adipose tissue. Subjects were treated according to an ICP-targeted therapy based on the Lund concept. 48 patients (mean age of 35.5 years and a median GCS of 6 [3-8]) were included. We found no significant effect of prostacyclin (epoprostenol, Flolan) on either the lactate-pyruvate ratio (L/P) at 24 h or the brain glucose levels. There was no significant difference in clinical outcome between the two groups. The median Glasgow Outcome Score (GOS) at 3 months was 4, and mortality was 12.5%. The favorable outcome (GOS 4-5) was 52%. The initial L/P did not prognosticate for outcome. Thus our results indicate that there is no effect of PGI(2) at a dose of 0.5 ng/kg/min on brain L/P, brain glucose levels, or outcome at 3 months.
Olivecrona
Magnus
M
Department of Neurosurgery, Umeå University Hospital, Umeå, Sweden.
Rodling-Wahlström
Marie
M
Naredi
Silvana
S
Koskinen
Lars-Owe D
LO
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000188:drug therapy*; D004311:Double-Blind Method; D011464:Epoprostenol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D011464:Epoprostenol