Margot Kelly-Hedrick, Sunny Yang Liu, Nancy Temkin, Jason Barber, Jordan Komisarow, Geoffrey Manley, Tetsu Ohnuma, Katharine Colton, Miriam M Treggiari, Eric E Monson, Monica S Vavilala, Ramesh Grandhi, Daniel T Laskowitz, Joseph P Mathew, Adrian Hernandez, Michael L James, Karthik Raghunathan, Ben Goldstein, Amy J Markowitz, Vijay Krishnamoorthy
{"title":"中重度颅脑损伤危重患者早期β受体阻滞剂暴露与功能结局的关系:一项临床研究和颅脑损伤研究的转变","authors":"Margot Kelly-Hedrick, Sunny Yang Liu, Nancy Temkin, Jason Barber, Jordan Komisarow, Geoffrey Manley, Tetsu Ohnuma, Katharine Colton, Miriam M Treggiari, Eric E Monson, Monica S Vavilala, Ramesh Grandhi, Daniel T Laskowitz, Joseph P Mathew, Adrian Hernandez, Michael L James, Karthik Raghunathan, Ben Goldstein, Amy J Markowitz, Vijay Krishnamoorthy","doi":"10.1097/CCE.0000000000000958","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to 1) describe patterns of beta-blocker utilization among critically ill patients following moderate-severe traumatic brain injury (TBI) and 2) examine the association of early beta-blocker exposure with functional and clinical outcomes following injury.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>ICUs at 18 level I, U.S. trauma centers in the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study.</p><p><strong>Patients: </strong>Greater than or equal to 17 years enrolled in the TRACK-TBI study with moderate-severe TBI (Glasgow Coma Scale of <13) were admitted to the ICU after a blunt TBI.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements: </strong>Primary exposure was a beta blocker during the first 7 days in the ICU, with a primary outcome of 6-month Glasgow Outcome Scale-Extended (GOSE). Secondary outcomes included: length of hospital stay, in-hospital mortality, 6-month and 12-month mortality, 12-month GOSE score, and 6-month and 12-month measures of disability, well-being, quality of life, and life satisfaction.</p><p><strong>Main results: </strong>Of the 450 eligible participants, 57 (13%) received early beta blockers (BB<sup>+</sup> group). The BB<sup>+</sup> group was on average older, more likely to be on a preinjury beta blocker, and more likely to have a history of hypertension. In the BB<sup>+</sup> group, 34 participants (60%) received metoprolol only, 19 participants (33%) received propranolol only, 3 participants (5%) received both, and 1 participant (2%) received atenolol only. In multivariable regression, there was no difference in the odds of a higher GOSE score at 6 months between the BB<sup>+</sup> group and BB<sup>-</sup> group (odds ratio = 0.86; 95% CI, 0.48-1.53). There was no association between BB exposure and secondary outcomes.</p><p><strong>Conclusions: </strong>About one-sixth of subjects in our study received early beta blockers, and within this group, dose, and timing of beta-blocker administration varied substantially. No significant differences in GOSE score at 6 months were demonstrated, although our ability to draw conclusions is limited by overall low total doses administered compared with prior studies.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 9","pages":"e0958"},"PeriodicalIF":0.0000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/08/ff/cc9-5-e0958.PMC10484371.pdf","citationCount":"0","resultStr":"{\"title\":\"Association of Early Beta-Blocker Exposure and Functional Outcomes in Critically Ill Patients With Moderate to Severe Traumatic Brain Injury: A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study.\",\"authors\":\"Margot Kelly-Hedrick, Sunny Yang Liu, Nancy Temkin, Jason Barber, Jordan Komisarow, Geoffrey Manley, Tetsu Ohnuma, Katharine Colton, Miriam M Treggiari, Eric E Monson, Monica S Vavilala, Ramesh Grandhi, Daniel T Laskowitz, Joseph P Mathew, Adrian Hernandez, Michael L James, Karthik Raghunathan, Ben Goldstein, Amy J Markowitz, Vijay Krishnamoorthy\",\"doi\":\"10.1097/CCE.0000000000000958\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>We aimed to 1) describe patterns of beta-blocker utilization among critically ill patients following moderate-severe traumatic brain injury (TBI) and 2) examine the association of early beta-blocker exposure with functional and clinical outcomes following injury.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>ICUs at 18 level I, U.S. trauma centers in the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study.</p><p><strong>Patients: </strong>Greater than or equal to 17 years enrolled in the TRACK-TBI study with moderate-severe TBI (Glasgow Coma Scale of <13) were admitted to the ICU after a blunt TBI.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements: </strong>Primary exposure was a beta blocker during the first 7 days in the ICU, with a primary outcome of 6-month Glasgow Outcome Scale-Extended (GOSE). Secondary outcomes included: length of hospital stay, in-hospital mortality, 6-month and 12-month mortality, 12-month GOSE score, and 6-month and 12-month measures of disability, well-being, quality of life, and life satisfaction.</p><p><strong>Main results: </strong>Of the 450 eligible participants, 57 (13%) received early beta blockers (BB<sup>+</sup> group). The BB<sup>+</sup> group was on average older, more likely to be on a preinjury beta blocker, and more likely to have a history of hypertension. In the BB<sup>+</sup> group, 34 participants (60%) received metoprolol only, 19 participants (33%) received propranolol only, 3 participants (5%) received both, and 1 participant (2%) received atenolol only. In multivariable regression, there was no difference in the odds of a higher GOSE score at 6 months between the BB<sup>+</sup> group and BB<sup>-</sup> group (odds ratio = 0.86; 95% CI, 0.48-1.53). There was no association between BB exposure and secondary outcomes.</p><p><strong>Conclusions: </strong>About one-sixth of subjects in our study received early beta blockers, and within this group, dose, and timing of beta-blocker administration varied substantially. No significant differences in GOSE score at 6 months were demonstrated, although our ability to draw conclusions is limited by overall low total doses administered compared with prior studies.</p>\",\"PeriodicalId\":10759,\"journal\":{\"name\":\"Critical Care Explorations\",\"volume\":\"5 9\",\"pages\":\"e0958\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/08/ff/cc9-5-e0958.PMC10484371.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care Explorations\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/CCE.0000000000000958\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Explorations","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/CCE.0000000000000958","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Association of Early Beta-Blocker Exposure and Functional Outcomes in Critically Ill Patients With Moderate to Severe Traumatic Brain Injury: A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study.
Objectives: We aimed to 1) describe patterns of beta-blocker utilization among critically ill patients following moderate-severe traumatic brain injury (TBI) and 2) examine the association of early beta-blocker exposure with functional and clinical outcomes following injury.
Design: Retrospective cohort study.
Setting: ICUs at 18 level I, U.S. trauma centers in the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study.
Patients: Greater than or equal to 17 years enrolled in the TRACK-TBI study with moderate-severe TBI (Glasgow Coma Scale of <13) were admitted to the ICU after a blunt TBI.
Interventions: None.
Measurements: Primary exposure was a beta blocker during the first 7 days in the ICU, with a primary outcome of 6-month Glasgow Outcome Scale-Extended (GOSE). Secondary outcomes included: length of hospital stay, in-hospital mortality, 6-month and 12-month mortality, 12-month GOSE score, and 6-month and 12-month measures of disability, well-being, quality of life, and life satisfaction.
Main results: Of the 450 eligible participants, 57 (13%) received early beta blockers (BB+ group). The BB+ group was on average older, more likely to be on a preinjury beta blocker, and more likely to have a history of hypertension. In the BB+ group, 34 participants (60%) received metoprolol only, 19 participants (33%) received propranolol only, 3 participants (5%) received both, and 1 participant (2%) received atenolol only. In multivariable regression, there was no difference in the odds of a higher GOSE score at 6 months between the BB+ group and BB- group (odds ratio = 0.86; 95% CI, 0.48-1.53). There was no association between BB exposure and secondary outcomes.
Conclusions: About one-sixth of subjects in our study received early beta blockers, and within this group, dose, and timing of beta-blocker administration varied substantially. No significant differences in GOSE score at 6 months were demonstrated, although our ability to draw conclusions is limited by overall low total doses administered compared with prior studies.
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