Effect of indomethacin on edema following single and repetitive cerebral ischemia in the gerbil.

Deluga, Karl S.; Plötz, Frans B.; Betz, A. Lorris

doi:10.1161/01.str.22.10.1259

Cited by 29 publications

(5 citation statements)

References 19 publications

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“…9 Third, it is also probable that the beneficial effects of indomethacin infusion could be due to nonvascular actions on baseline ICP in pathological conditions such as ischemic and vasogenic edema. 1,4,14 Decreased production of cerebrospinal fluid following endothelin potentiation has been recently demonstrated. 13 Although we did not record cerebral temperature, we did find that the effect of indomethacin could not be attributed to reduction in rectal temperature.…”

Section: Discussionmentioning

confidence: 99%

Use of indomethacin in brain-injured patients with cerebral perfusion pressure impairment: preliminary report

Biestro

Alberti²,

Soca³

et al. 1995

Journal of Neurosurgery

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The effect of indomethacin, a cyclooxygenase inhibitor, was studied in the treatment of 10 patients with head injury and one patient with spontaneous subarachnoid hemorrhage, each of whom presented with high intracranial pressure (ICP) (34.4 +/- 13.1 mm Hg) and cerebral perfusion pressure (CPP) impairment (67.0 +/- 15.4 mm Hg), which did not improve with standard therapy using mannitol, hyperventilation, and barbiturates. The patient had Glasgow Coma Scale scores of 8 or less. Recordings were made of the patients' ICP and mean arterial blood pressure from the nurse's end-hour recording at the bedside, as well as of their CPP, rectal temperature, and standard therapy regimens. The authors assessed the effects of an indomethacin bolus (50 mg in 20 minutes) on ICP and CPP; an indomethacin infusion (21.5 +/- 11 mg/hour over 30 +/- 9 hours) on ICP, CPP, rectal temperature, and standard therapy regimens (matching the values before and during infusion in a similar time interval); and discontinuation of indomethacin treatment on ICP, CPP, and rectal temperature. The indomethacin bolus was very effective in lowering ICP (p < 0.0005) and improving CPP (p < 0.006). The indomethacin infusion decreased ICP (p < 0.02), but did not improve CPP and rectal temperature. The effects of standard therapy regimens before and during indomethacin infusion showed no significant changes, except in three patients in whom mannitol reestablished its action on ICP and CPP. Sudden discontinuation of indomethacin treatment was followed by significant ICP rebound. The authors suggest that indomethacin may be considered one of the frontline agents for raised ICP and CPP impairment.

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Section: Discussionmentioning

confidence: 99%

Use of indomethacin in brain-injured patients with cerebral perfusion pressure impairment: preliminary report

Biestro

Alberti²,

Soca³

et al. 1995

Journal of Neurosurgery

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“…Cerebral metabolism is preserved during this vasoconstrictive phase [23]. Second, indomethacin may reduce brain edema as demonstrated in animal models of TBI and stroke that have been pretreated [39,40]. The proposed mechanism is still unclear, though postulated to be related to reduction in arachidonic acid and prostaglandin levels.…”

Section: Discussionmentioning

confidence: 99%

Indomethacin for Control of ICP

et al. 2014

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non-English, retrospective studies, no documentation of ICP response to indomethacin, and animal studies. A two-tier filter of references was conducted. First, we screened manuscripts by title and abstract. Second, those references passing the first filter were pulled, and the full manuscript was checked to see if it matched the criteria for inclusion. Two reviewers independently extracted data including population characteristics and treatment characteristics. The strength of evidence was adjudicated using both the Oxford and GRADE methodology. Our search strategy produced a total of 208 citations. Twelve original articles, 10 manuscripts, and 2 meeting proceeding, were considered for the review with all utilizing indomethacin, while documenting ICP in neurological patients. All studies were prospective. Across all studies, there were a total of 177 patients studied, with 152 receiving indomethacin and 25 serving as controls in a variety of heterogeneous studies. All but one study documented a decrease in ICP with indomethacin administration, with both bolus and continuous infusions. No significant complications were described. There currently exists Oxford level 2b, GRADE C evidence to support that indomethacin reduces ICP in the severe TBI population. Similar conclusions in other populations cannot be made at this time. Comments on its impact, on patient outcome, and side effects cannot be made given the available data. At this time, indomethacin for ICP control remains experimental and further prospective study is warranted.

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“…Indomethacin is a cyclooxygenase inhibitor which acts in a similar manner to hyperventilation in that it is a vasoconstrictor and reduces CBF, but without affecting CMRO 2 [136]. It has also been shown to lower ICP in animals by decreasing cerebral edema [137] and CSF production [138]. Indomethacin was used in the treatment of elevated ICP by Biestro and co-workers recently; one hour after infusion there was a significant reduction in ICP and an increase in the CPP [139].…”

Section: Indomethacinmentioning

confidence: 99%

Outcome from traumatic brain injury

Jallo¹,

Shutter²

1998

Trauma Quarterly

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Traumatic brain injury (TBI) continues to be a significant public health issue. Advances in acute medical care after brain injury have improved mortality, but the morbidity from residual neurological deficits remains high. Multiple variables have been shown to have an impact on the outcome from TBI and, although many of these factors are not modifiable, a number of them can be influenced by medical interventions. Multidimensional assessments of the early clinical findings can provide some predictions regarding the potential for recovery after TBI. In addition, an awareness of the modifiable factors may assist with the prevention of secondary injury and optimization of the long-term outcome. Certain neurodiagnostic studies can be used to supplement the patients' physical findings and help guide medical management. Finally, rehabilitation services have documented benefit in the TBI population and are being initiated earlier in the course of medical care. This article attempts to review many of these variables and provide information on the clinical outcomes following TBI.

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Effect of indomethacin on edema following single and repetitive cerebral ischemia in the gerbil.

Cited by 29 publications

References 19 publications

Use of indomethacin in brain-injured patients with cerebral perfusion pressure impairment: preliminary report

Use of indomethacin in brain-injured patients with cerebral perfusion pressure impairment: preliminary report

Indomethacin for Control of ICP

Outcome from traumatic brain injury

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