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Effects of prostacyclin on the early inflammatory response in patients with traumatic brain injury-a randomised clinical study
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.
Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
The Sahlgrenska Academy, University of Gothenburg.
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2014 (English)In: SpringerPlus, ISSN 2193-1801, Vol. 3, 98- p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE AND DESIGN: A prospective, randomised, double-blinded, clinical trial was performed at a level 1 trauma centre to determine if a prostacyclin analogue, epoprostenol (Flolan®), could attenuate systemic inflammatory response in patients with severe traumatic brain injury (TBI).

SUBJECTS: 46 patients with severe TBI, randomised to epoprostenol (n = 23) or placebo (n = 23).

TREATMENT: Epoprostenol, 0.5 ng · kg(-1) · min(-1), or placebo (saline) was given intravenously for 72 hours and then tapered off over the next 24 hours.

METHODS: Interleukin-6 (IL-6), interleukin-8 (IL-8), soluble intracellular adhesion molecule-1 (sICAM-1), C-reactive protein (CRP), and asymmetric dimethylarginine (ADMA) levels were measured over five days. Measurements were made at 24 h intervals ≤24 h after TBI to 97-120 h after TBI.

RESULTS: A significantly lower CRP level was detected in the epoprostenol group compared to the placebo group within 73-96 h (p = 0.04) and within 97-120 h (p = 0.008) after trauma. IL-6 within 73-96 h after TBI was significantly lower in the epoprostenol group compared to the placebo group (p = 0.04). ADMA was significantly increased within 49-72 h and remained elevated, but there was no effect of epoprostenol on ADMA levels. No significant differences between the epoprostenol and placebo groups were detected for IL-8 or sICAM-1.

CONCLUSIONS: Administration of the prostacyclin analogue epoprostenol significantly decreased CRP and, to some extent, IL-6 levels in patients with severe TBI compared to placebo. These findings indicate an interesting option for treatment of TBI and warrants future larger studies.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier, NCT01363583.

Place, publisher, year, edition, pages
Springer, 2014. Vol. 3, 98- p.
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:umu:diva-88003DOI: 10.1186/2193-1801-3-98PubMedID: 24600548OAI: oai:DiVA.org:umu-88003DiVA: diva2:713075
Available from: 2014-04-18 Created: 2014-04-18 Last updated: 2014-04-23Bibliographically approved

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Olivecrona, MagnusAhlm, ClasKoskinen, Lars-Owe DNaredi, SilvanaHultin, Magnus

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