Indomethacin for Control of ICP

Abstract

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.

Idiopathic intracranial hypertension: consensus guidelines on management

“…Indomethacin may have some advantage due to its effect of reducing ICP. 50 Caution is required with potential side effects of NSAIDs, and gastric protection may be needed.…”

Indomethacin for intracranial hypertension secondary to severe traumatic brain injury in adults

“…We found no randomised studies conducted on this topic, but we did find a review that assessed the use of indomethacin and its e ects on intracranial pressure (ICP) in patients with neurological illness (Sader 2015). This review defined eligible studies as being prospective, with five or more participants who had a documented response to indomethacin, and with trial reports published in English.…”

“…Sader 2015 stated that nine out of 10 studies documented a decrease in ICP with indomethacin administration, and concluded that evidence provided by these studies suggested that indomethacin may reduce ICP in the severe TBI population. However, studies which did not show an e ect of indomethacin on ICP were not eligible for inclusion in the review, so indomethacin for ICP control remains experimental and further prospective studies are needed (Sader 2015). Only two studies included in the Sader 2015 review reported adverse events related to indomethacin administration: one was a study of people with severe TBI, where there was a critical reduction in jugular venous oxygen saturation in two of the six patients treated with indomethacin; and the other was a study of idiopathic intracranial hypertension which described dizziness in four patients.…”