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.

Details

Title
The impact of sedative and vasopressor agents on cerebrovascular reactivity in severe traumatic brain injury
Author
Froese, Logan 1   VIAFID ORCID Logo  ; Hammarlund, Emma 2 ; Åkerlund, Cecilia A. I. 3 ; Tjerkaski, Jonathan 4 ; Hong, Erik 4 ; Lindblad, Caroline 5 ; Nelson, David W. 3 ; Thelin, Eric P. 6 ; Zeiler, Frederick A. 7 

1  University of Manitoba, Biomedical Engineering, Faculty of Engineering, Winnipeg, Canada (GRID:grid.21613.37) (ISNI:0000 0004 1936 9609) 
2  Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden (GRID:grid.4714.6) (ISNI:0000 0004 1937 0626); Karolinska University Hospital, Department of Perioperative Medicine and Intensive Care, Stockholm, Sweden (GRID:grid.24381.3c) (ISNI:0000 0000 9241 5705) 
3  Karolinska University Hospital, Department of Perioperative Medicine and Intensive Care, Stockholm, Sweden (GRID:grid.24381.3c) (ISNI:0000 0000 9241 5705); Karolinska Institutet, Section of Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Stockholm, Sweden (GRID:grid.4714.6) (ISNI:0000 0004 1937 0626) 
4  Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden (GRID:grid.4714.6) (ISNI:0000 0004 1937 0626) 
5  Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden (GRID:grid.4714.6) (ISNI:0000 0004 1937 0626); Uppsala University Hospital, Department of Neurosurgery, Uppsala, Sweden (GRID:grid.412354.5) (ISNI:0000 0001 2351 3333); Uppsala University, Department of Medical Sciences, Uppsala, Sweden (GRID:grid.8993.b) (ISNI:0000 0004 1936 9457) 
6  Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden (GRID:grid.4714.6) (ISNI:0000 0004 1937 0626); Karolinska University Hospital, Department of Neurology, Stockholm, Sweden (GRID:grid.24381.3c) (ISNI:0000 0000 9241 5705) 
7  University of Manitoba, Biomedical Engineering, Faculty of Engineering, Winnipeg, Canada (GRID:grid.21613.37) (ISNI:0000 0004 1936 9609); Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden (GRID:grid.4714.6) (ISNI:0000 0004 1937 0626); University of Manitoba, Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, Canada (GRID:grid.21613.37) (ISNI:0000 0004 1936 9609); University of Manitoba, Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, Winnipeg, Canada (GRID:grid.21613.37) (ISNI:0000 0004 1936 9609); University of Manitoba, Centre On Aging, Winnipeg, Canada (GRID:grid.21613.37) (ISNI:0000 0004 1936 9609); University of Cambridge, Division of Anaesthesia, Department of Medicine, Addenbrooke’s Hospital, Cambridge, UK (GRID:grid.5335.0) (ISNI:0000000121885934) 
Pages
54
Publication year
2023
Publication date
Dec 2023
Publisher
Springer Nature B.V.
e-ISSN
2197425X
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s40635-023-00524-4
ProQuest document ID
2845967376
Copyright
© The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.