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Open Access

Beta-adrenergic blockade for attenuation of catecholamine surge after traumatic brain injury: a randomized pilot trial

Thomas J Schroeppel, John P Sharpe, Charles Patrick Shahan, Lesley P Clement, Louis J. Magnotti, Marilyn Lee, Michael Muhlbauer, Jordan A Weinberg, Elizabeth A Tolley, Martin A Croce, Timothy C Fabian
DOI: 10.1136/tsaco-2019-000307 Published 18 August 2019
Thomas J Schroeppel
1Department of Acute Care Surgery, UCHealth Memorial Hospital Central, Colorado Springs, Colorado, USA
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John P Sharpe
2Department of Surgery, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
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Charles Patrick Shahan
2Department of Surgery, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
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Lesley P Clement
3Department of Pharmacy, UCHealth Memorial Hospital Central, Colorado Springs, Colorado, USA
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Louis J. Magnotti
2Department of Surgery, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
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Marilyn Lee
4Department of Pharmacy, Regional One Health, Memphis, Tennessee, USA
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Michael Muhlbauer
5Department of Neurosurgery, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
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Jordan A Weinberg
6Department of Surgery, Dignity Health Medical Group Arizona, Phoenix, Arizona, USA
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Elizabeth A Tolley
7Department of Preventative Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Martin A Croce
2Department of Surgery, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
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Timothy C Fabian
2Department of Surgery, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
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Article Figures & Data

Figures

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  • Figure 1
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    Figure 1

    CONSORT flow diagram for study population. AIS, Abbreviated Injury Scale; GCS, Glasgow Coma Scale.

  • Figure 2
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    Figure 2

    Least square means (±SE) plot of heart rate (beats per minute) comparing the treatment group (propranolol) to control. *Indicates difference between groups with p<0.05.

  • Figure 3
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    Figure 3

    Least square means (±SE) plot. Mean arterial pressure (mm Hg) comparing the treatment group (propranolol) to control. *Indicates difference between groups with p<0.05.

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    Figure 4

    Least square means (±SE) plot of Glasgow Coma Scale score comparing the treatment group (propranolol) to control. *Indicates difference between groups with p<0.05.

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    Figure 5

    Kaplan-Meier survival analysis. Treatment=propranolol group. No difference between groups with p=0.708.

  • Figure 6
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    Figure 6

    Least square means (±SE) of total urinary catecholamines (μg/L) comparing the treatment group (propranolol) to control.

Tables

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  • Table 1

    Descriptive statistics comparing PRO to the control group

    Total studyPROControlP value
    n=25n=13n=12
    Age (years)51.3 (±20.1)49.7 (±19.0)53.0 (±21.9)0.689
    Female36.0%30.8%41.7%0.688
    Caucasian60.0%61.5%58.3%0.999
    Blunt88.0%84.6%91.7%0.999
    ISS21.8 (±5.0)21.9 (±4.2)21.8 (±5.5)0.965
    Head AIS4 (3, 4)3 (3, 4)4 (3, 4)0.611
    LOS (days)32.6 (±37.5)30.7 (±12.0)34.8 (±53.9)0.799
    ICU LOS (days)16.0 (±6.9)16.3 (±7.1)15.7 (±6.9)0.821
    Admit BD (meq/L)−3.6 (±3.9)−4.8 (±2.6)−2.4 (±4.7)0.132
    Admit lactate (mmol/L)2.5 (±1.7)2.2 (±1.3)2.8 (±2.1)0.371
    Charlson Index1 (0, 2)1 (0, 2)2 (0.5, 3.5)0.351
    Transfusions (units)0 (0, 1)0 (0, 2)0 (0, 0)0.389
    Ventilator days13.4 (±6.2)13.4 (±6.3)13.5 (±6.3)0.964
    Mortality20.0%7.7%33.3%0.109
    • Categorical variables expressed as percentages. Continuous variables expressed at mean (±SD) or median (IQR).

    • AIS, Abbreviated Injury Scale; BD, base deficit; ICU LOS, intensive care unit length of stay; ISS, Injury Severity Score; LOS, length of stay; PRO, propranolol; SBP, systolic blood pressure.

Supplementary Materials

  • Figures
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  • Supplementary data

    [tsaco-2019-000307supp001.pdf]

  • Supplementary data

    [tsaco-2019-000307supp002.pdf]

  • Supplementary data

    [tsaco-2019-000307supp003.pdf]

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Beta-adrenergic blockade for attenuation of catecholamine surge after traumatic brain injury: a randomized pilot trial
Thomas J Schroeppel, John P Sharpe, Charles Patrick Shahan, Lesley P Clement, Louis J. Magnotti, Marilyn Lee, Michael Muhlbauer, Jordan A Weinberg, Elizabeth A Tolley, Martin A Croce, Timothy C Fabian
Trauma Surg Acute Care Open Aug 2019, 4 (1) e000307; DOI: 10.1136/tsaco-2019-000307

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Beta-adrenergic blockade for attenuation of catecholamine surge after traumatic brain injury: a randomized pilot trial
Thomas J Schroeppel, John P Sharpe, Charles Patrick Shahan, Lesley P Clement, Louis J. Magnotti, Marilyn Lee, Michael Muhlbauer, Jordan A Weinberg, Elizabeth A Tolley, Martin A Croce, Timothy C Fabian
Trauma Surg Acute Care Open Aug 2019, 4 (1) e000307; DOI: 10.1136/tsaco-2019-000307
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Beta-adrenergic blockade for attenuation of catecholamine surge after traumatic brain injury: a randomized pilot trial
Thomas J Schroeppel, John P Sharpe, Charles Patrick Shahan, Lesley P Clement, Louis J. Magnotti, Marilyn Lee, Michael Muhlbauer, Jordan A Weinberg, Elizabeth A Tolley, Martin A Croce, Timothy C Fabian
Trauma Surgery & Acute Care Open Aug 2019, 4 (1) e000307; DOI: 10.1136/tsaco-2019-000307
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