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Neurocritical Care
Erschienen in: Neurocritical Care 2/2015

01.04.2015 | Review Article

The Role of Neuromuscular Blockade in Patients with Traumatic Brain Injury: A Systematic Review

verfasst von: Filippo Sanfilippo, Cristina Santonocito, Tonny Veenith, Marinella Astuto, Marc O. Maybauer

Erschienen in: Neurocritical Care | Ausgabe 2/2015

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Abstract

Management of Traumatic Brain Injury (TBI) focuses on controlling intracranial pressure (ICP), while other treatments, such as the use of neuromuscular blocking agents (NMBAs), need scientific evidence. We conducted a systematic review to investigate the usefulness of NMBAs in the context of TBI and/or increased ICP. We searched MEDLINE and EMBASE databases up to January 31st 2014, including both clinical and experimental findings. We found a total of 34 articles, of which 22 were prospective clinical trials. No systematic review/meta-analyses were found. Seven studies evaluated NMBA boluses in preventing stimulation-related ICP surges: paralysis was effective during tracheal suctioning and physiotherapy but not during bronchoscopy. Fourteen small studies (8 to 25 patients) assessed the effect of NMBA boluses on ICP. Two studies showed an ICP increase by succinylcholine and one found a decrease in ICP after atracurium. No ICP changes were observed in the other studies. One prospective study confirmed that discontinuing paralysis increases energy expenditure. Two retrospective studies investigated mortality/morbidity: one found that early paralysis (continued for >12 h) was not beneficial and potentially associated with extra-cranial complications, while the second demonstrated a correlation between continuous infusion of NMBA and time spent with ICP > 20 mmHg. Eight animal studies were also retrieved. In most studies, NMBA bolus was beneficial in controlling ICP, especially when performing stimulating procedures. However, retrospective evidence found potential harm by continuous NMBA infusion. In the context of TBI patients, we discuss the potentially positive effects of paralysis with its negative ones. Well-conducted randomized controlled trials and/or large pharmaco-epidemiologic studies are warranted.
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Metadaten
Titel
The Role of Neuromuscular Blockade in Patients with Traumatic Brain Injury: A Systematic Review
verfasst von
Filippo Sanfilippo
Cristina Santonocito
Tonny Veenith
Marinella Astuto
Marc O. Maybauer
Publikationsdatum
01.04.2015
Verlag
Springer US
Erschienen in
Neurocritical Care / Ausgabe 2/2015
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-014-0061-1

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