Abstract | OBJECTIVE: METHODS: Ten volume-resuscitated brain-injured patients who were treated with pentobarbital infusion for intracranial hypertension and underwent PbtO2 monitoring were studied in a neurosurgical intensive care unit at a university-based Level I trauma center. PbtO2, intracranial pressure (ICP), mean arterial pressure, cerebral perfusion pressure ( CPP), and brain temperature were continuously monitored and compared in settings in which barbiturates were or were not administered. RESULTS: Data were available from 1595 hours of PbtO2 monitoring. When pentobarbital administration began, the mean ICP, CPP, and PbtO2 were 18 +/- 10, 72 +/- 18, and 28 +/- 12 mm Hg, respectively. During the 3 hours before barbiturate infusion, the maximum ICP was 24 +/- 13 mm Hg and the minimum CPP was 65 +/- 20 mm Hg. In the majority of patients (70%), we observed an increase in PbtO2 associated with pentobarbital infusion. Within this group, logistic regression analysis demonstrated that a higher likelihood of compromised brain oxygen (PbtO2 < 20 mm Hg) was associated with a decrease in pentobarbital dose after controlling for ICP and other physiological parameters (P < 0.001). In the remaining 3 patients, pentobarbital was associated with lower PbtO2 levels. These patients had higher ICP, lower CPP, and later initiation of barbiturates compared with patients whose PbtO2 increased. CONCLUSION: Our preliminary findings suggest that pentobarbital administered for intractable intracranial hypertension is associated with a significant and independent increase in PbtO2 in the majority of patients. However, in some patients with more compromised brain physiology, pentobarbital may have a negative effect on PbtO2, particularly if administered late. Larger studies are needed to examine the relationship between barbiturates and cerebral oxygenation in brain-injured patients with refractory intracranial hypertension and to determine whether PbtO2 responses can help guide therapy.
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Authors | H Isaac Chen, Neil R Malhotra, Mauro Oddo, Gregory G Heuer, Joshua M Levine, Peter D LeRoux |
Journal | Neurosurgery
(Neurosurgery)
Vol. 63
Issue 5
Pg. 880-6; discussion 886-7
(Nov 2008)
ISSN: 1524-4040 [Electronic] United States |
PMID | 19005378
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Adult
- Aged
- Barbiturates
(administration & dosage)
- Brain
(blood supply, drug effects, metabolism)
- Brain Injuries
(complications, physiopathology)
- Critical Care
(methods)
- Dose-Response Relationship, Drug
- Female
- Humans
- Infusions, Intravenous
- Intracranial Hypertension
(drug therapy, etiology, physiopathology)
- Intracranial Pressure
(drug effects)
- Male
- Middle Aged
- Monitoring, Physiologic
- Oxygen
(metabolism)
- Retrospective Studies
- Treatment Outcome
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