Acute management of acquired brain injury part II: an evidence-based review of pharmacological interventions.
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.
Meyer
Matthew J
MJ
Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada.
Megyesi
Joseph
J
Meythaler
Jay
J
Murie-Fernandez
Manuel
M
Aubut
Jo-Anne
JA
Foley
Norine
N
Salter
Katherine
K
Bayley
Mark
M
Marshall
Shawn
S
Teasell
Robert
R
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
D000700:Analgesics; D004232:Diuretics