Prophylactic barbiturate step-down infusion therapy has similar and favorable effects in elderly and non-elderly patients with severe traumatic brain injuries

IF 1.3 Q4 CLINICAL NEUROLOGY

Brain Hemorrhages Pub Date : 2025-08-01 DOI:10.1016/j.hest.2024.10.002

Sosho Kajiwara , Yu Hasegawa , Jin Kikuchi , Kiyohiko Sakata , Tetsuya Negoto , Yukihiko Nakamura , Takayuki Kawano , Yusuke Otsu , Yoshikuni Kotaki , Hideo Nakamura , Masaru Hirohata , Motohiro Morioka

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Abstract

Objective: With the aging population, the number of elderly patients with severe traumatic brain injury (sTBI) inevitably increases. The high mortality rate for sTBI in the elderly necessitates effective solutions. While we have previously reported the beneficial effects of a novel barbiturate therapy, a prophylactic step-down infusion of barbiturates (sdB), using thiamylal with normothermia (NOR) in patients with sTBI, its effects on elderly patients remain unclear. This study aimed to compare the efficacy and safety of sdB between elderly and non-elderly patients with sTBI.

Methods: We included 25 sTBI patients treated with sdB+NOR between January 2013 and March 2020. Patients were stratified into elderly (≥75 years, n = 8) and non-elderly (<75 years, n = 17) groups. Patient characteristics were similar between groups except for sex ratio. Outcomes compared included primary endpoints (favorable outcome at discharge and at 6–12 months), secondary endpoints (composite death at discharge and at 6–12 months), side effects, complications, intracranial pressure (ICP), cerebral perfusion pressure (CPP) control, and hospitalization period.

Results: The hospitalization period tended to be longer in elderly patients. There were no significant differences in the incidence of side effects or complications related to sdB between the groups. Both primary (favorable outcome) and secondary (composite death) endpoints were similar at discharge and at 6-12 months for elderly and non-elderly patients. ICP and CPP were well controlled in the elderly patients.

Conclusion: The results suggest that sdB+NOR is as effective and safe for elderly patients with sTBI as it is for non-elderly patients.

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预防性巴比妥酸降压输注治疗老年和非老年重型颅脑损伤患者疗效相似且良好

目的：随着人口老龄化，老年重型颅脑损伤（sTBI）患者数量不可避免地增加。老年人sTBI的高死亡率需要有效的解决办法。虽然我们之前报道了一种新型巴比妥类药物治疗的有益效果，即预防性降压输注巴比妥类药物（sdB），在sTBI患者中使用硫氨酰胺和正常体温（NOR），但其对老年患者的影响尚不清楚。本研究旨在比较sdB在老年和非老年sTBI患者中的疗效和安全性。方法：我们纳入了2013年1月至2020年3月期间接受sdB+NOR治疗的25例sTBI患者。将患者分为老年组（≥75岁，n = 8）和非老年组（≥75岁，n = 17）。除性别比例不同外，两组患者特征相似。比较的结果包括主要终点（出院时和6-12个月时的有利结局）、次要终点（出院时和6-12个月时的复合死亡）、副作用、并发症、颅内压（ICP）、脑灌注压（CPP）控制和住院时间。结果：老年患者住院时间有延长的趋势。两组间与sdB相关的副作用或并发症发生率无显著差异。老年和非老年患者的主要终点（有利结局）和次要终点（复合死亡）在出院时和6-12个月时相似。老年患者ICP、CPP控制良好。结论：sdB+NOR治疗老年sTBI患者与非老年患者一样安全有效。

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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