The Effect of Early Beta-Blockade with Esmolol on Therapy Intensity Level in Adults with Severe Traumatic Brain Injury.

IF 1.8 Q3 CLINICAL NEUROLOGY
Neurotrauma reports Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI:10.1089/neur.2024.0055
Thomas Baumer, George Higginbotham, Kati Hayes, Matt Thomas
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引用次数: 0

Abstract

Following severe traumatic brain injury (TBI), elevated catecholamine levels are associated with worsened secondary brain injury and poorer clinical outcomes. The mechanisms are uncertain but may include cerebral ischemia and blood-brain barrier disruption, with consequent cerebral edema manifesting as intracranial hypertension. Early beta-blockade (EBB) may mitigate these detrimental hyperadrenergic effects. Therapy Intensity Level (TIL) is a validated score that quantifies intracranial pressure (ICP)-lowering interventions, with higher TIL being a surrogate for more severe intracranial hypertension. In this post hoc secondary analysis of a dose-finding study of EBB with esmolol in adults with TBI, we compared summary TIL (TIL24) and domain TIL between patients who received esmolol and those who did not. The primary outcome was TIL24 for each 24-h epoch of the esmolol intervention period of 96 h. Baseline characteristics were comparable in the esmolol (E) and non-esmolol (NE) groups. Mean TIL24 was similar in both groups up to 48 h but then diverged. The mean (standard deviation) TIL24 score between 48 and 72 h was 4.8 (1.5) in group E versus 6.6 (5.4) in group NE and at 72-96 h 4.5 (1.5) in group E versus 7.0 (4.0) in group NE. TIL domain scores were lower in group E for hyperosmolar therapy, targeted temperature management, and surgical management (cerebrospinal fluid drainage, evacuation, or decompressive craniectomy). The association between esmolol use after TBI and the reduction in ICP-directed interventions is consistent with an effect of beta-blockade on reduction of cerebral edema. Further research is necessary to determine causality and mechanism.

早期β-受体阻滞剂与艾司洛尔对严重创伤性脑损伤成人治疗强度水平的影响》(The Effect of Early Beta-Blockade with Esmolol on Therapy Intensity Level in Adults with Severe Traumatic Brainjury)。
严重创伤性脑损伤(TBI)后,儿茶酚胺水平升高与继发性脑损伤恶化和较差的临床预后有关。其机制尚不确定,但可能包括脑缺血和血脑屏障破坏,从而导致脑水肿,表现为颅内高压。早期β受体阻滞剂(EBB)可减轻这些有害的高肾上腺素能效应。治疗强度水平(TIL)是对降低颅内压(ICP)的干预措施进行量化的有效评分,TIL越高,代表颅内高压越严重。在这项针对成人创伤性脑损伤患者的艾司洛尔 EBB 剂量试验研究的事后二次分析中,我们比较了接受艾司洛尔治疗和未接受艾司洛尔治疗的患者的总 TIL(TIL24)和域 TIL。艾司洛尔(E)组与非艾司洛尔(NE)组的基线特征相当。两组的平均 TIL24 在 48 小时内相似,但随后出现了差异。48 小时至 72 小时期间,E 组的 TIL24 平均得分(标准差)为 4.8(1.5)分,而 NE 组为 6.6(5.4)分;72 小时至 96 小时期间,E 组的 TIL24 平均得分(标准差)为 4.5(1.5)分,而 NE 组为 7.0(4.0)分。E组在高渗治疗、目标体温管理和手术管理(脑脊液引流、排空或减压开颅术)方面的TIL域评分较低。创伤性脑损伤后使用艾司洛尔与ICP定向干预减少之间的关联与β-受体阻滞剂对减轻脑水肿的作用一致。有必要开展进一步研究,以确定因果关系和机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.40
自引率
0.00%
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0
审稿时长
8 weeks
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