Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury

Introduction: Experimental research has demonstrated that the level of neuroprotection conferred by the various barbiturates is not equal. Until now no controlled studies have been conducted to compare their effectiveness, even though the Brain Trauma Foundation Guidelines recommend that such studie...

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Autores: Pérez Bárcena, Juan, Llompart Pou, Juan A., Homar, Javier, Abadal, Josep M., Raurich, Joan M., Frontera, Guillem, Brell, Marta, Ibáñez, Javier, Ibáñez, Jordi
Tipo de recurso: artículo
Fecha de publicación:2008
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:113557
Acceso en línea:https://ddd.uab.cat/record/113557
https://dx.doi.org/urn:doi:10.1186/cc6999
Access Level:acceso abierto
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spelling Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injurya randomized controlled trialPérez Bárcena, JuanLlompart Pou, Juan A.Homar, JavierAbadal, Josep M.Raurich, Joan M.Frontera, GuillemBrell, MartaIbáñez, JavierIbáñez, JordiIntroduction: Experimental research has demonstrated that the level of neuroprotection conferred by the various barbiturates is not equal. Until now no controlled studies have been conducted to compare their effectiveness, even though the Brain Trauma Foundation Guidelines recommend that such studies be undertaken. The objectives of the present study were to assess the effectiveness of pentobarbital and thiopental in terms of controlling refractory intracranial hypertension in patients with severe traumatic brain injury, and to evaluate the adverse effects of treatment. Methods: This was a prospective, randomized, cohort study comparing two treatments: pentobarbital and thiopental. Patients who had suffered a severe traumatic brain injury (Glasgow Coma Scale score after resuscitation ≤ 8 points or neurological deterioration during the first week after trauma) and with refractory intracranial hypertension (intracranial pressure > 20 mmHg) first-tier measures, in accordance with the Brain Trauma Foundation Guidelines. Results: A total of 44 patients (22 in each group) were included over a 5-year period. There were no statistically significant differences in ' baseline characteristics, except for admission computed cranial tomography characteristics, using the Traumatic Coma Data Bank classification. Uncontrollable intracranial pressure occurred in 11 patients (50%) in the thiopental treatment group and in 18 patients (82%) in the pentobarbital group (P = 0.03). Under logistic regression analysis - undertaken in an effort to adjust for the cranial tomography characteristics, which were unfavourable for pentobarbital - thiopental was more effective than pentobarbital in terms of controlling intracranial pressure (odds ratio = 5.1, 95% confidence interval 1.2 to 21.9; P = 0.027). There were no significant differences between the two groups with respect to the incidence of arterial hypotension or infection. Conclusions: Thiopental appeared to be more effective than pentobarbital in controlling intracranial hypertension refractory to first-tier measures. These findings should be interpreted with caution because of the imbalance in cranial tomography characteristics and the different dosages employed in the two arms of the study. The incidence of adverse effects was similar in both groups. 22008-01-0120082008-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/113557https://dx.doi.org/urn:doi:10.1186/cc6999reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/3.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:1135572026-06-06T12:50:31Z
dc.title.none.fl_str_mv Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury
a randomized controlled trial
title Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury
spellingShingle Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury
Pérez Bárcena, Juan
title_short Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury
title_full Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury
title_fullStr Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury
title_full_unstemmed Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury
title_sort Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury
dc.creator.none.fl_str_mv Pérez Bárcena, Juan
Llompart Pou, Juan A.
Homar, Javier
Abadal, Josep M.
Raurich, Joan M.
Frontera, Guillem
Brell, Marta
Ibáñez, Javier
Ibáñez, Jordi
author Pérez Bárcena, Juan
author_facet Pérez Bárcena, Juan
Llompart Pou, Juan A.
Homar, Javier
Abadal, Josep M.
Raurich, Joan M.
Frontera, Guillem
Brell, Marta
Ibáñez, Javier
Ibáñez, Jordi
author_role author
author2 Llompart Pou, Juan A.
Homar, Javier
Abadal, Josep M.
Raurich, Joan M.
Frontera, Guillem
Brell, Marta
Ibáñez, Javier
Ibáñez, Jordi
author2_role author
author
author
author
author
author
author
author
description Introduction: Experimental research has demonstrated that the level of neuroprotection conferred by the various barbiturates is not equal. Until now no controlled studies have been conducted to compare their effectiveness, even though the Brain Trauma Foundation Guidelines recommend that such studies be undertaken. The objectives of the present study were to assess the effectiveness of pentobarbital and thiopental in terms of controlling refractory intracranial hypertension in patients with severe traumatic brain injury, and to evaluate the adverse effects of treatment. Methods: This was a prospective, randomized, cohort study comparing two treatments: pentobarbital and thiopental. Patients who had suffered a severe traumatic brain injury (Glasgow Coma Scale score after resuscitation ≤ 8 points or neurological deterioration during the first week after trauma) and with refractory intracranial hypertension (intracranial pressure > 20 mmHg) first-tier measures, in accordance with the Brain Trauma Foundation Guidelines. Results: A total of 44 patients (22 in each group) were included over a 5-year period. There were no statistically significant differences in ' baseline characteristics, except for admission computed cranial tomography characteristics, using the Traumatic Coma Data Bank classification. Uncontrollable intracranial pressure occurred in 11 patients (50%) in the thiopental treatment group and in 18 patients (82%) in the pentobarbital group (P = 0.03). Under logistic regression analysis - undertaken in an effort to adjust for the cranial tomography characteristics, which were unfavourable for pentobarbital - thiopental was more effective than pentobarbital in terms of controlling intracranial pressure (odds ratio = 5.1, 95% confidence interval 1.2 to 21.9; P = 0.027). There were no significant differences between the two groups with respect to the incidence of arterial hypotension or infection. Conclusions: Thiopental appeared to be more effective than pentobarbital in controlling intracranial hypertension refractory to first-tier measures. These findings should be interpreted with caution because of the imbalance in cranial tomography characteristics and the different dosages employed in the two arms of the study. The incidence of adverse effects was similar in both groups.
publishDate 2008
dc.date.none.fl_str_mv 2
2008-01-01
2008
2008-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/113557
https://dx.doi.org/urn:doi:10.1186/cc6999
url https://ddd.uab.cat/record/113557
https://dx.doi.org/urn:doi:10.1186/cc6999
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/3.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/3.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
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