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Effect of cerebral perfusion pressure augmentation with dopamine and norepinephrine on global and focal brain oxygenation after traumatic brain injury.

Abstract：

OBJECTIVE:To compare the effects of a cerebral perfusion pressure (CPP) intervention achieved with dopamine and norepinephrine after severe head injury. DESIGN:Prospective, controlled, trial. SETTING:Neurosciences critical care unit. PATIENTS:Eleven patients with a head injury, requiring dopamine or norepinephrine infusions to support CPP. INTERVENTION:Cerebral tissue gas measurements were recorded using a multimodal sensor, and regional chemistry was assessed using microdialysis. Patients received in, randomised order, either dopamine or norepinephrine to achieve and maintain a CPP of 65 mmHg, and then, following a 30-min period of stable haemodynamics, a CPP of 85 mmHg. Data were then acquired using the second agent. Haemodynamic measurements and measurements of cerebral physiology were made during each period. MEASUREMENTS AND RESULTS:The CPP augmentation with norepinephrine, but not with dopamine, resulted in a significant reduction in arterial-venous oxygen difference (37+/-11 vs 33+/-12 ml/l) and a significant increase in brain tissue oxygen (2.6+/-1.1 vs 3.0+/-1.1 kPa). The CPP intervention did not significantly affect intracranial pressure. There were no significant differences between norepinephrine and dopamine on cerebral oxygenation or metabolism either at baseline or following a CPP intervention; however, the response to a CPP intervention with dopamine seemed to be more variable than the response achieved with norepinephrine. CONCLUSIONS:If CPP is to be raised to a level higher than 65-70 mmHg, then it is important to recognise that the response to the intervention may be unpredictable and that the vasoactive agent used may be of importance.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Johnston AJ,Steiner LA,Chatfield DA,Coles JP,Hutchinson PJ,Al-Rawi PG,Menon DK,Gupta AK

doi

10.1007/s00134-003-2155-7

keywords:

subject

Has Abstract

pub_date

2004-05-01 00:00:00

pages

791-7

issue

eissn

0342-4642

issn

1432-1238

journal_volume

pub_type

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Effect of cerebral perfusion pressure augmentation with dopamine and norepinephrine on global and focal brain oxygenation after traumatic brain injury.