Controlling Hyperadrenergic Activity in Neurologic Injury
| Status: | Not yet recruiting |
|---|---|
| Conditions: | Hospital, Neurology |
| Therapuetic Areas: | Neurology, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/2/2016 |
| Start Date: | July 2011 |
Traumatic brain injury (TBI) is frequently associated with a hyperadrenergic state
accompanied by elevated levels of plasma catecholamines. In its more severe presentation,
the hyperadrenergic state presents as dysautonomia, which is characterized by paroxysmal
alteration in vital signs, including tachycardia. The investigators hypothesize that
intravenous (IV) esmolol is as effective at controlling heart rate in hyperadrenergic states
as oral propranolol, which is the standard of care. Our primary endpoint is efficacy of IV
esmolol vs a PRN regimen of intermittent B-blockade in controlling heart rate below a
pre-specified level (< 100 bpm) after Traumatic Brain Injury (TBI). Heart rates will be
recorded continuously as well as hourly.
accompanied by elevated levels of plasma catecholamines. In its more severe presentation,
the hyperadrenergic state presents as dysautonomia, which is characterized by paroxysmal
alteration in vital signs, including tachycardia. The investigators hypothesize that
intravenous (IV) esmolol is as effective at controlling heart rate in hyperadrenergic states
as oral propranolol, which is the standard of care. Our primary endpoint is efficacy of IV
esmolol vs a PRN regimen of intermittent B-blockade in controlling heart rate below a
pre-specified level (< 100 bpm) after Traumatic Brain Injury (TBI). Heart rates will be
recorded continuously as well as hourly.
Inclusion Criteria:
- TBI (Moderate/Severe TBI (GCS 12 or Head AIS>1)
- Hyperadrenergic Activity: At least one paroxysmal episode (lasting at least 15
minutes) of Heart Rate 110 beats per minute during two or more consecutive days plus
at least two more of the following that may not be better explained by another
disease process (ex: sepsis):
Temperature of 38.5C Respiratory Rate 20 breaths per minute Agitation Diaphoresis Dystonia
Stimulus responsive ("triggering of paroxysm")
- Informed Consent obtained
Exclusion Criteria:
- Patients that do not meet criteria for dysautonomia (as stated above)
- Age <18 years
- Pregnancy
- Hypotension - requiring pressor therapy to maintain baseline adequate CPP or mean
arterial pressure
- Cardiac arrhythmia - sinus bradycardia (HR <60), 2nd or 3rd degree AV block
- Hemodynamic contraindications to intravenous beta-blockade such as a documented
history of congestive heart failure (CHF), dependency on cardiac inotropes or
documented bronchospastic disease
- Any patient on chronic beta blockade as an outpatient.
- Life expectancy < 48 hours or patients with "do not resuscitate orders"
- Ongoing seizure activity
- Informed consent not obtained
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