The impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injury
Abstract Background The aim of this study is to evaluate the impact of commonly administered sedatives (Propofol, Alfentanil, Fentanyl, and Midazolam) and vasopressor (Dobutamine, Ephedrine, Noradrenaline and Vasopressin) agents on cerebrovascular reactivity in moderate/severe TBI patients. Cerebrov...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-08-01
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| Series: | Intensive Care Medicine Experimental |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40635-023-00524-4 |
| _version_ | 1797454143893274624 |
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| author | Logan Froese Emma Hammarlund Cecilia A. I. Åkerlund Jonathan Tjerkaski Erik Hong Caroline Lindblad David W. Nelson Eric P. Thelin Frederick A. Zeiler |
| author_facet | Logan Froese Emma Hammarlund Cecilia A. I. Åkerlund Jonathan Tjerkaski Erik Hong Caroline Lindblad David W. Nelson Eric P. Thelin Frederick A. Zeiler |
| author_sort | Logan Froese |
| collection | DOAJ |
| description | Abstract Background The aim of this study is to evaluate the impact of commonly administered sedatives (Propofol, Alfentanil, Fentanyl, and Midazolam) and vasopressor (Dobutamine, Ephedrine, Noradrenaline and Vasopressin) agents on cerebrovascular reactivity in moderate/severe TBI patients. Cerebrovascular reactivity, as a surrogate for cerebral autoregulation was assessed using the long pressure reactivity index (LPRx). We evaluated the data in two phases, first we assessed the minute-by-minute data relationships between different dosing amounts of continuous infusion agents and physiological variables using boxplots, multiple linear regression and ANOVA. Next, we assessed the relationship between continuous/bolus infusion agents and physiological variables, assessing pre-/post- dose of medication change in physiology using a Wilcoxon signed-ranked test. Finally, we evaluated sub-groups of data for each individual dose change per medication, focusing on key physiological thresholds and demographics. Results Of the 475 patients with an average stay of 10 days resulting in over 3000 days of recorded information 367 (77.3%) were male with a median Glasgow coma score of 7 (4–9). The results of this retrospective observational study confirmed that the infusion of most administered agents do not impact cerebrovascular reactivity, which is confirmed by the multiple linear regression components having p value > 0.05. Incremental dose changes or bolus doses in these medications in general do not lead to significant changes in cerebrovascular reactivity (confirm by Wilcoxon signed-ranked p value > 0.05 for nearly all assessed relationships). Within the sub-group analysis that separated the data based on LPRx pre-dose, a significance between pre-/post-drug change in LPRx was seen, however this may be more of a result from patient state than drug impact. Conclusions Overall, this study indicates that commonly administered agents with incremental dosing changes have no clinically significant influence on cerebrovascular reactivity in TBI (nor do they impair cerebrovascular reactivity). Though further investigation in a larger and more diverse TBI patient population is required. |
| first_indexed | 2024-03-09T15:33:02Z |
| format | Article |
| id | doaj.art-466b7af5ec1640e18d92fb88c9d97ecf |
| institution | Directory Open Access Journal |
| issn | 2197-425X |
| language | English |
| last_indexed | 2024-03-09T15:33:02Z |
| publishDate | 2023-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj.art-466b7af5ec1640e18d92fb88c9d97ecf2023-11-26T12:08:48ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2023-08-0111111210.1186/s40635-023-00524-4The impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injuryLogan Froese0Emma Hammarlund1Cecilia A. I. Åkerlund2Jonathan Tjerkaski3Erik Hong4Caroline Lindblad5David W. Nelson6Eric P. Thelin7Frederick A. Zeiler8Biomedical Engineering, Faculty of Engineering, University of ManitobaDepartment of Clinical Neuroscience, Karolinska InstitutetDepartment of Perioperative Medicine and Intensive Care, Karolinska University HospitalDepartment of Clinical Neuroscience, Karolinska InstitutetDepartment of Clinical Neuroscience, Karolinska InstitutetDepartment of Clinical Neuroscience, Karolinska InstitutetDepartment of Perioperative Medicine and Intensive Care, Karolinska University HospitalDepartment of Clinical Neuroscience, Karolinska InstitutetBiomedical Engineering, Faculty of Engineering, University of ManitobaAbstract Background The aim of this study is to evaluate the impact of commonly administered sedatives (Propofol, Alfentanil, Fentanyl, and Midazolam) and vasopressor (Dobutamine, Ephedrine, Noradrenaline and Vasopressin) agents on cerebrovascular reactivity in moderate/severe TBI patients. Cerebrovascular reactivity, as a surrogate for cerebral autoregulation was assessed using the long pressure reactivity index (LPRx). We evaluated the data in two phases, first we assessed the minute-by-minute data relationships between different dosing amounts of continuous infusion agents and physiological variables using boxplots, multiple linear regression and ANOVA. Next, we assessed the relationship between continuous/bolus infusion agents and physiological variables, assessing pre-/post- dose of medication change in physiology using a Wilcoxon signed-ranked test. Finally, we evaluated sub-groups of data for each individual dose change per medication, focusing on key physiological thresholds and demographics. Results Of the 475 patients with an average stay of 10 days resulting in over 3000 days of recorded information 367 (77.3%) were male with a median Glasgow coma score of 7 (4–9). The results of this retrospective observational study confirmed that the infusion of most administered agents do not impact cerebrovascular reactivity, which is confirmed by the multiple linear regression components having p value > 0.05. Incremental dose changes or bolus doses in these medications in general do not lead to significant changes in cerebrovascular reactivity (confirm by Wilcoxon signed-ranked p value > 0.05 for nearly all assessed relationships). Within the sub-group analysis that separated the data based on LPRx pre-dose, a significance between pre-/post-drug change in LPRx was seen, however this may be more of a result from patient state than drug impact. Conclusions Overall, this study indicates that commonly administered agents with incremental dosing changes have no clinically significant influence on cerebrovascular reactivity in TBI (nor do they impair cerebrovascular reactivity). Though further investigation in a larger and more diverse TBI patient population is required.https://doi.org/10.1186/s40635-023-00524-4AutoregulationCerebrovascular reactivitySedative drugsVasopressors |
| spellingShingle | Logan Froese Emma Hammarlund Cecilia A. I. Åkerlund Jonathan Tjerkaski Erik Hong Caroline Lindblad David W. Nelson Eric P. Thelin Frederick A. Zeiler The impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injury Intensive Care Medicine Experimental Autoregulation Cerebrovascular reactivity Sedative drugs Vasopressors |
| title | The impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injury |
| title_full | The impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injury |
| title_fullStr | The impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injury |
| title_full_unstemmed | The impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injury |
| title_short | The impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injury |
| title_sort | impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injury |
| topic | Autoregulation Cerebrovascular reactivity Sedative drugs Vasopressors |
| url | https://doi.org/10.1186/s40635-023-00524-4 |
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