title: Vasopressin for cerebral perfusion pressure management in patients with severe traumatic brain injury: preliminary results of a randomized controlled trial.
abstract: BACKGROUND
  After traumatic brain injury (TBI), catecholamines (CAs) may be needed to maintain adequate cerebral perfusion pressure (CPP), but there are no recommended alternative vasopressor therapies. This is an interim report of the first study to test the hypothesis that arginine vasopressin (AVP) is a safe and effective alternative to CAs for the management of CPP in patients with severe TBI.
  
  
  METHODS
  Since 2008, all TBI patients requiring intracranial pressure monitoring at this Level 1 trauma center have been eligible for a randomized trial to receive either CA or AVP if vasopressors were required to maintain CPP greater than 60 mm Hg.
  
  
  RESULTS
  To date, 96 patients have been consented and randomized. Demographics, vital signs, and laboratory values were similar. As treated, 60 required no vasopressors and were the least severely injured group with the best outcomes. Twenty-three patients received CA (70% levophed, 22% dopamine, 9% phenylephrine) and 12 patients received AVP. The two vasopressor groups had similar demographics, but Injury Severity Score (ISS) and fluid requirements on intensive care unit Day 1 were worse in the AVP versus the CA groups (all p < 0.05) before treatment. These differences indicate more severe injury with accompanying hemodynamic instability. Nevertheless, adverse events were not increased with AVP versus CA. Trends favored AVP versus CA, but no apparent differences were statistically significant at this interim point. There was no difference in mortality rates between CA and AVP.
  
  
  CONCLUSIONS
  These preliminary results suggest that AVP is a safe and effective alternative to CA for the management of CPP after TBI and support the continued investigation and use of AVP when vasopressors are required for CPP management in TBI patients.
  
  
  METHODS
  Therapeutic study, level II.
authors.affiliation: From the Dewitt-Daughtry Family Department of Surgery and Department of Neurosurgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Van Haren
authors.forename: Chad M
authors.initials: CM
authors.lastname: Thorson
authors.forename: Michael P
authors.initials: MP
authors.lastname: Ogilvie
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Valle
authors.forename: Gerardo A
authors.initials: GA
authors.lastname: Guarch
authors.forename: Jassin A
authors.initials: JA
authors.lastname: Jouria
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Busko
authors.forename: Leo T
authors.initials: LT
authors.lastname: Harris
authors.forename: M Ross
authors.initials: MR
authors.lastname: Bullock
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Jagid
authors.forename: Alan S
authors.initials: AS
authors.lastname: Livingstone
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Proctor
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D001930:Brain Injuries / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007427:Intracranial Pressure / Q000187:drug effects*; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins