title: Vasopressor use and effect on blood pressure after severe adult traumatic brain injury.
abstract: BACKGROUND
  We describe institutional vasopressor usage, and examine the effect of vasopressors on hemodynamics: heart rate (HR), mean arterial blood pressure (MAP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), brain tissue oxygenation (PbtO(2)), and jugular venous oximetry (SjVO(2)) in adults with severe traumatic brain injury (TBI).
  
  
  METHODS
  We performed a retrospective analysis of 114 severely head injured patients who were admitted to the neurocritical care unit of Level 1 trauma center and who received vasopressors (phenylephrine, norepinephrine, dopamine, vasopressin or epinephrine) to increase blood pressure
  
  
  RESULTS
  Phenylephrine was the most commonly used vasopressor (43%), followed by norepinephrine (30%), dopamine (22%), and vasopressin (5%). Adjusted for age, gender, injury severity score, vasopressor dose, baseline blood pressure, fluid administration, propofol sedation, and hypertonic saline infusion, phenylephrine use was associated with 8 mmHg higher mean arterial pressure (MAP) than dopamine (P = 0.03), and 12 mmHg higher cerebral perfusion pressure (CPP) than norepinephrine (P = 0.02) during the 3 h after vasopressor start. There was no difference in ICP between the drug groups, either at baseline or after vasopressor treatment.
  
  
  CONCLUSIONS
  Most severe TBI patients received phenylephrine. Patients who received phenylephrine had higher MAP and CPP than patients who received dopamine and norepinephrine, respectively.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Pimwan
authors.initials: P
authors.lastname: Sookplung
authors.forename: Arunotai
authors.initials: A
authors.lastname: Siriussawakul
authors.forename: Amin
authors.initials: A
authors.lastname: Malakouti
authors.forename: Deepak
authors.initials: D
authors.lastname: Sharma
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Souter
authors.forename: Randall M
authors.initials: RM
authors.lastname: Chesnut
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D004298:Dopamine / Q000627:therapeutic use; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D009638:Norepinephrine / Q000627:therapeutic use; D010656:Phenylephrine / Q000627:therapeutic use; D012189:Retrospective Studies; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins; D010656:Phenylephrine; D004298:Dopamine; D009638:Norepinephrine