Prospective evaluation of early propranolol after traumatic brain injury.

Abstract

BACKGROUND:

Although beta-adrenergic receptor blockade may improve outcomes after traumatic brain injury (TBI), its early use is not routine. We hypothesize that judicious early low-dose propranolol after TBI (EPAT) will improve outcomes without altering bradycardia or hypotensive events.

METHODS:

We conducted a prospective, observational study on all patients who presented with moderate-to-severe TBI from March 2010-August 2013. Ten initial patients did not receive propranolol (control). Subsequent patients received propranolol at 1-mg intravenous every 6 h starting within 12 h of intensive care unit (ICU) admission (EPAT) for a minimum of 48 h. Heart rate and blood pressure were recorded hourly for the first 72 h. Bradycardia and hypotensive events, mortality, and length of stay (LOS) were compared between cohorts to determine significant differences.

RESULTS:

Thirty-eight patients were enrolled; 10 control and 28 EPAT. The two cohorts were similar when compared by gender, emergency department (ED) systolic blood pressure, ED heart rate, and mortality. ED Glasgow coma scale was lower (4.2 versus 10.7, P < 0.01) and injury severity score higher in control. EPAT patients received a mean of 10 ± 14 doses of propranolol. Hypotensive events were similar between cohorts, whereas bradycardia events were higher in control (5.8 versus 1.6, P = 0.05). ICU LOS (15.4 versus 30.4 d, P = 0.02) and hospital LOS (10 versus 19.1 d, P = 0.05) were lower in EPAT. Mortality rates were similar between groups (10% versus 10.7%, P = 0.9). The administration of propranolol led to no recorded complications.

CONCLUSIONS:

Although bradycardia and hypotensive events occur early after TBI, low-dose intravenous propranolol does not increase their number or severity. Early use of propranolol after TBI appears to be safe and may be associated with decreased ICU and hospital LOS.

• Authors: Jason S Murry, David M Hoang, Galinos Barmparas, Megan Y Harada, Marko Bukur, Matthew B Bloom, Kenji Inaba, Daniel R Margulies, Ali Salim, Eric J Ley
• Journal: The Journal of surgical research (J Surg Res) Vol. 200 Issue 1 Pg. 221-6 (Jan 2016) ISSN: 1095-8673 [Electronic] United States
• PMID: 26188959 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Adrenergic beta-Antagonists
• Propranolol

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Adult
• Aged
• Bradycardia (chemically induced)
• Brain Injuries (complications, drug therapy)
• Drug Administration Schedule
• Female
• Humans
• Hypotension (chemically induced)
• Injections, Intravenous
• Injury Severity Score
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• Propranolol (therapeutic use)
• Prospective Studies
• Treatment Outcome