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.
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Acknowledgements
A. Johnston is supported by a grant from Codman. L. Steiner is supported by a Myron B. Laver Grant (Department of Anaesthesia, University of Basel, Switzerland) and grants from the Margarete und Walter Lichtenstein-Stiftung (Basel, Switzerland) and the Swiss National Science Foundation. He is recipient of an Overseas Research Student Award (Committee of Vice-Chancellors and Principals of the Universities of the United Kingdom). J. Coles is a Wellcome research training fellow. P. Al-Rawi is currently supported by a grant from the Stroke Association. Work of the department is supported by a grant from the Medical Research Council (grant no. G 9439390 ID56833).
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Johnston, A.J., Steiner, L.A., Chatfield, D.A. et al. Effect of cerebral perfusion pressure augmentation with dopamine and norepinephrine on global and focal brain oxygenation after traumatic brain injury. Intensive Care Med 30, 791–797 (2004). https://doi.org/10.1007/s00134-003-2155-7
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DOI: https://doi.org/10.1007/s00134-003-2155-7