Sedatives and analgesics for critically ill patients with severe traumatic brain injury during target temperature management (Experience in Japan Neuro Trauma Data Bank Project 2015)

DOI
  • Miyata Kei
    Department of Neurosurgery, Sapporo Medical University Department of Emergency Medicine, Sapporo Medical University The Japan Neurotrauma Data Bank Committee (The Japan Society of Neurotraumatology)
  • Yamaoka Ayumu
    Department of Neurosurgery, Sapporo Medical University
  • Aisaka Wakiko
    Department of Emergency Medicine, Sapporo Medical University
  • Kasai Takehiko
    Department of Emergency Medicine, Sapporo Medical University
  • Kyan Ryoko
    Department of Emergency Medicine, Sapporo Medical University
  • Bunya Naofumi
    Department of Emergency Medicine, Sapporo Medical University
  • Narimatsu Eichi
    Department of Emergency Medicine, Sapporo Medical University The Japan Neurotrauma Data Bank Committee (The Japan Society of Neurotraumatology)
  • Mikuni Nobuhiro
    Department of Neurosurgery, Sapporo Medical University The Japan Neurotrauma Data Bank Committee (The Japan Society of Neurotraumatology)

Bibliographic Information

Other Title
  • 頭部外傷データバンクプロジェクト2015における重症頭部外傷患者の集中治療：積極的体温管理下における鎮静鎮痛管理の検討
Published
2019-12-30
DOI
  • 10.32187/neurotraumatology.42.2_103
Publisher
The Japan Society of Neurotraumatology

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Description

<p>Introduction: Protocols for sedative drugs in patients with severe head traumatic brain injury have not been established. The purpose of this study was to investigate sedatives based on target temperature man­age­ment (TTM).</p><p>Subjects and Methods: Data from 1345 patients were obtained from the Japan Neurotrauma Data Bank Project 2015, a cohort observational study. Patients with non–active treatment at trauma resuscitation, cardiac arrest, or no medical treatment were excluded, leaving 787 patients in this study. The use of neuro–intensive drugs including sedatives, analgesic and neuromuscular blocking drugs (NMBDs) in adults and children was examined. The patients were divided into three groups: (1) the non–temperature control (NC) group treated with no TTM; (2) the aggressive normothermia therapy (NT) group treated with aggressive normothermia group; and (3) the mild hypothermia therapy (HT) group with mild hypothermia management. We compared the sedatives, analgesia, and NMBDs in the three groups.</p><p>Results: For sedatives, propofol (PROP) was often used in 45% in adults. Midazolam (MDZ) and dexmedetomidine (DEX) are more commonly used in pediatric compared with adult patients (p<0.001, 0.04). Two or more sedatives were administered in 15% of adults and 12% pediatric patients. In adults, DEX was often administered in the NT group, and MDZ in the HT group. Analgesics was used in 53% of NT and 73% of HT patients. NMBDs were used for 10% of NT and 40% of HT patients.</p><p>Conclusion: Currently, neuro–intensive care such as TTM that is based on the pathological condition has become common, and it is necessary to also show the optimal protocol in for sedative management of severe traumatic brain injuries.</p>

Journal

  • Neurotraumatology

    Neurotraumatology 42 (2), 103-108, 2019-12-30

    The Japan Society of Neurotraumatology

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