Vasopressin for cerebral perfusion pressure management in patients with severe traumatic brain injury

Abstract

Therapeutic study, level II.

Vasopressin Increases Cerebral Perfusion Pressure but not Cerebral Blood Flow in Neurosurgical Patients with Catecholamine-Refractory Hypotension: A Preliminary Evaluation Using the Non-Invasive Quantix ND in Comparison to the Literature

“…But this is no standard at all since there exists no level I eidence so far that even an ICP/CPP guided therapy has any beneficial effects on patient outcome after TBI. The findings of Van Harren et al [19] suggest that the distubances in normal autoregulation especially in peripheral arterioles and brain function after TBI are complex and may take effect on various levels. The influence of vasopressin on oxytocin receptors leading to vasodilation [19] are overridden on a dose dependent manner by vasopressin related activation of AVPR1a and thus vasoconstriction.…”

“…The findings of Van Harren et al [19] suggest that the distubances in normal autoregulation especially in peripheral arterioles and brain function after TBI are complex and may take effect on various levels. The influence of vasopressin on oxytocin receptors leading to vasodilation [19] are overridden on a dose dependent manner by vasopressin related activation of AVPR1a and thus vasoconstriction. This might be the reason for the beneficial effect of vasopressin after TBI seen by Dudkiewicz and Proctor [18] & Van Harren et al [19].…”

“…Despite the fact that vasopressin enhances cerebral edema after ischemia [16,29] and also leads to a increased rebleeding rate in an animal model of SAH [30], some recent studies demonstrated that AVP is safe to use after TBI using the increase in MAP and CPP as endpoints [19,31] or in an animal model where cerebral oxygenation was also studied [18]. But to our knowledge this preliminary study is the first to measure not only the changes in MAP and CPP but put the focus of attention to changes in cerebral blood flow (CBF) after AVP application.…”

“…Interestingly in a model for blunt trauma to the head and chest showed that the use of AVP was as effective as phenylephrine to maintain CPP but improved ICP and cerebral tissue oxygenation [18]. In 2013 Van Haren et al [19] published a paper concerning the use of vasopressin for CPP management in patients with severe traumatic brain injury.…”

“…Since the vasocontrictive potency of AVP is well known and the study by Van Haren et al [19] didn't measure cerebral blood flow (CBF) or brain tissue oxygenation (P bt O 2 ) the present preliminary study was carried out to evaluate the influence of AVP on CPP, ICP and CBF in neurosurgical patients suffering from catecholamine refractory hypotension.…”