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Prostacyclin treatment and clinical outcome in severe traumatic brain injury patients managed with an ICP-targeted therapy: A prospective study
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
2012 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 26, no 1, 67-75 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To prospectively assess clinical outcome in patients with severe traumatic brain injury (sTBI) managed according to an ICP-targeted programme as well as additional treatment with prostacyclin.

Materials and methods: Inclusion criteria were GCS <= 8, age 15-70 years, first recorded cerebral perfusion pressure (CPP)>10mmHg. Exclusion criteria were pregnancy, breastfeeding or penetrating brain injury. The patients were treated using the same ICP-guided protocol, with one group randomized to receive prostacyclin in a low dose (0.5 ng kg(-1) min(-1)). The clinical outcome was prospectively assessed at 3, 6, 12, 18 and 24 months using structured interviews.

Results: Forty-eight patients were included, mean age 35.5 years, median GCS 6 (3-8), 69% were multi-traumatized. Mortality at 3 months was 12.5%. Median Glasgow Outcome Scale (GOS) at all follow-up points was 4. Favourable outcome (GOS 4-5) at 3 months was 52%, at 24 months 64%. Favourable outcome increased over time. There was a statistically significant association between GOS, GCS at admission and age. Higher ICP(max) was associated with worse outcome.

Conclusion: With this treatment protocol, a low number of deaths and a high number of favourable outcomes in sTBI were observed. Prostacyclin in this low dose does not seem to improve the outcome. ICP(max) is a positive predictor of worse outcome. Higher GCS at admission and lower age are correlated to better outcome.

Place, publisher, year, edition, pages
London: Informa Healthcare, 2012. Vol. 26, no 1, 67-75 p.
Keyword [en]
Outcome, long-time, severe traumatic brain injury, ICP, prostacyclin
National Category
Neurosciences
Identifiers
URN: urn:nbn:se:umu:diva-50918DOI: 10.3109/02699052.2011.635351ISI: 000297787900007OAI: oai:DiVA.org:umu-50918DiVA: diva2:480984
Available from: 2012-01-20 Created: 2012-01-02 Last updated: 2017-12-08Bibliographically approved

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Olivecrona, MagnusRodling-Wahlstrom, MarieNaredi, SilvanaKoskinen, Lars-Owe D.
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