title: Acute management of acquired brain injury part II: an evidence-based review of pharmacological interventions.
abstract: OBJECTIVE
  To review the research literature on pharmacological interventions used in the acute phase of acquired brain injury (ABI) to manage ICP and improve neural recovery.
  
  
  RESULTS
  A literature search of multiple databases (CINAHL, EMBASE, MEDLINE and PSYCHINFO) and hand searched articles covering the years 1980-2008 was performed. Peer reviewed articles were assessed for methodological quality using the PEDro scoring system for randomized controlled trials (RCTs) and the Downs and Black tool for RCTs and non-randomized trials. Levels of evidence were assigned and recommendations were made.
  
  
  RESULTS
  In total, 11 pharmacological interventions used in the acute management of ABI were evaluated. These included propofol, barbiturates, opioids, midazolam, mannitol, hypertonic saline, corticosteroids, progesterone, bradykinin antagonists, dimethyl sulphoxide and cannabinoids. Of these interventions, corticosteroids were found to be contraindicated and cannabinoids were reported as ineffective. The other nine interventions demonstrated some benefit for treatment of acute ABI. However, rarely did these benefits result in improved long-term patient outcomes.
  
  
  CONCLUSIONS
  Substantial research has been devoted to evaluating the use of pharmacological interventions in the acute management of ABI. However, much of this research has focused on the application of individual interventions in small single-site trials. Future research will need to establish larger patient samples to evaluate the benefits of combined interventions within specific patient populations.
authors.affiliation: Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Meyer
authors.forename: Joseph
authors.initials: J
authors.lastname: Megyesi
authors.forename: Jay
authors.initials: J
authors.lastname: Meythaler
authors.forename: Manuel
authors.initials: M
authors.lastname: Murie-Fernandez
authors.forename: Jo-Anne
authors.initials: JA
authors.lastname: Aubut
authors.forename: Norine
authors.initials: N
authors.lastname: Foley
authors.forename: Katherine
authors.initials: K
authors.lastname: Salter
authors.forename: Mark
authors.initials: M
authors.lastname: Bayley
authors.forename: Shawn
authors.initials: S
authors.lastname: Marshall
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications*; D004232:Diuretics / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006801:Humans; D019586:Intracranial Hypertension / Q000188:drug therapy* / Q000534:rehabilitation; D016032:Randomized Controlled Trials as Topic
chemical_list: D000700:Analgesics; D004232:Diuretics