A new systematic review examines data from controlled trials designed to investigate sedation and its effects on critically ill adults with severe traumatic brain injury (TBI). Researchers report that the goal of the work was to summarize randomized controlled trails about the effects of sedative agents on neurologic outcome, mortality, intracranial pressure, cerebral perfusion pressure, and adverse drug events in adult, critically ill TBI patients.
The research reportedly encompassed 13 randomized controlled trials, involving 380 patients. Researchers say long-term sedation was addressed in six of the studies and a bolus dose, short infusion, or doubling of plasma drug concentrating, was examined in the remaining trials.
Researchers note that most of the trials do not describe baseline TBI prognostic factors or important cointerventions. In addition, the researchers’ investigation indicated that data regarding the effects of sedative agents on neurologic outcome or mortality was insufficient. Researchers go on to hypothesize that despite potentially transient effects, bolus doses of opioids may heighten intracranial pressure and reduce cerebral perfusion pressure.
Results for one study involving the long-term infusion of propofol versus morphine indicated that the pair was reportedly linked with a reduced requirement for intracranial pressure-lowering cointerventions and lower intracranial pressure on the third day of treatment. Researchers say that additional trials of propofol versus midazolam, and ketamine versus sufentanil, suggested no difference between the agents in regard to changes in intracranial pressure and cerebral perfusion pressure.
The results of systematic review concluded that the trials yielded no evidence that indicated one sedative agent was more successful in improving patient outcomes, intracranial pressure, or cerebral perfusion pressure, than another the other.
However, researchers call for more randomized controlled trials in response to data that suggests high bolus doses of opioids may present exert potentially harmful effects to intracranial pressure and cerebral perfusion pressure.
The review was recently published in the journal Critical Care Medicine.
Source: Critical Care Medicine