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Association of Vasopressor Choice with Clinical and Functional Outcomes Following Moderate to Severe Traumatic Brain Injury: A TRACK-TBI Study.

Publication ,  Journal Article
Toro, C; Temkin, N; Barber, J; Manley, G; Jain, S; Ohnuma, T; Komisarow, J; Foreman, B; Korley, FK; Vavilala, MS; Laskowitz, DT; Mathew, JP ...
Published in: Neurocritical care
February 2022

Early hypotension following moderate to severe traumatic brain injury (TBI) is associated with increased mortality and poor long-term outcomes. Current guidelines suggest the use of intravenous vasopressors to support blood pressure following TBI; however, guidelines do not specify vasopressor type, resulting in variation in clinical practice. Minimal data are available to guide clinicians on optimal early vasopressor choice to support blood pressure following TBI. Therefore, we conducted a multicenter study to examine initial vasopressor choice for the support of blood pressure following TBI and its association with clinical and functional outcomes after injury.We conducted a retrospective cohort study of patients enrolled in the transforming research and clinical knowledge in traumatic brain injury (TRACK-TBI) study, an 18-center prospective cohort study of patients with TBI evaluated in participating level I trauma centers. We examined adults with moderate to severe TBI (defined as Glasgow Coma Scale score < 13) who were admitted to the intensive care unit and received an intravenous vasopressor within 48 h of admission. The primary exposure was initial vasopressor choice (phenylephrine versus norepinephrine), and the primary outcome was 6-month Glasgow Outcomes Scale Extended (GOSE), with the following secondary outcomes: length of hospital stay, length of intensive care unit stay, in-hospital mortality, new requirement for dialysis, and 6-month Disability Rating Scale. Regression analysis was used to assess differences in outcomes between patients exposed to norepinephrine versus phenylephrine, with propensity weighting to address selection bias due to the nonrandom allocation of the treatment groups and patient dropout.The final study sample included 156 patients, of whom 79 (51%) received norepinephrine, 69 (44%) received phenylephrine, and 8 (5%) received an alternate drug as their initial vasopressor. 121 (77%) of patients were men, with a mean age of 43.1 years. Of patients receiving norepinephrine as their initial vasopressor, 32% had a favorable outcome (GOSE 5-8), whereas 40% of patients receiving phenylephrine as their initial vasopressor had a favorable outcome. Compared with phenylephrine, exposure to norepinephrine was not significantly associated with improved 6-month GOSE (weighted odds ratio 1.40, 95% confidence interval 0.66-2.96, p = 0.37) or any secondary outcome.The majority of patients with moderate to severe TBI received either phenylephrine or norepinephrine as first-line agents for blood pressure support following brain injury. Initial choice of norepinephrine, compared with phenylephrine, was not associated with improved clinical or functional outcomes.

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Published In

Neurocritical care

DOI

EISSN

1556-0961

ISSN

1541-6933

Publication Date

February 2022

Volume

36

Issue

1

Start / End Page

180 / 191

Related Subject Headings

  • Vasoconstrictor Agents
  • Retrospective Studies
  • Prospective Studies
  • Neurology & Neurosurgery
  • Male
  • Humans
  • Glasgow Coma Scale
  • Brain Injuries, Traumatic
  • Adult
  • 4205 Nursing
 

Citation

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Toro, C., Temkin, N., Barber, J., Manley, G., Jain, S., Ohnuma, T., … TRACK-TBI Investigators, . (2022). Association of Vasopressor Choice with Clinical and Functional Outcomes Following Moderate to Severe Traumatic Brain Injury: A TRACK-TBI Study. Neurocritical Care, 36(1), 180–191. https://doi.org/10.1007/s12028-021-01280-7
Toro, Camilo, Nancy Temkin, Jason Barber, Geoffrey Manley, Sonia Jain, Tetsu Ohnuma, Jordan Komisarow, et al. “Association of Vasopressor Choice with Clinical and Functional Outcomes Following Moderate to Severe Traumatic Brain Injury: A TRACK-TBI Study.Neurocritical Care 36, no. 1 (February 2022): 180–91. https://doi.org/10.1007/s12028-021-01280-7.
Toro C, Temkin N, Barber J, Manley G, Jain S, Ohnuma T, et al. Association of Vasopressor Choice with Clinical and Functional Outcomes Following Moderate to Severe Traumatic Brain Injury: A TRACK-TBI Study. Neurocritical care. 2022 Feb;36(1):180–91.
Toro, Camilo, et al. “Association of Vasopressor Choice with Clinical and Functional Outcomes Following Moderate to Severe Traumatic Brain Injury: A TRACK-TBI Study.Neurocritical Care, vol. 36, no. 1, Feb. 2022, pp. 180–91. Epmc, doi:10.1007/s12028-021-01280-7.
Toro C, Temkin N, Barber J, Manley G, Jain S, Ohnuma T, Komisarow J, Foreman B, Korley FK, Vavilala MS, Laskowitz DT, Mathew JP, Hernandez A, Sampson J, James ML, Goldstein BA, Markowitz AJ, Krishnamoorthy V, TRACK-TBI Investigators. Association of Vasopressor Choice with Clinical and Functional Outcomes Following Moderate to Severe Traumatic Brain Injury: A TRACK-TBI Study. Neurocritical care. 2022 Feb;36(1):180–191.
Journal cover image

Published In

Neurocritical care

DOI

EISSN

1556-0961

ISSN

1541-6933

Publication Date

February 2022

Volume

36

Issue

1

Start / End Page

180 / 191

Related Subject Headings

  • Vasoconstrictor Agents
  • Retrospective Studies
  • Prospective Studies
  • Neurology & Neurosurgery
  • Male
  • Humans
  • Glasgow Coma Scale
  • Brain Injuries, Traumatic
  • Adult
  • 4205 Nursing