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Control of mean arterial pressure using a closed-loop system for norepinephrine infusion in severe brain injury patients: the COMAT randomized controlled trial.
Joosten, Alexandre; Rinehart, Joseph; Cannesson, Maxime; Coeckelenbergh, Sean; Pochard, Jonas; Vicaut, Eric; Duranteau, Jacques.
Affiliation
  • Joosten A; Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, Ronald Reagan Medical Center, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA. joosten-alexandre@hotmail.com.
  • Rinehart J; Department of Anesthesiology & Perioperative Care, University of California Irvine, California, CA, 92868, USA.
  • Cannesson M; Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, Ronald Reagan Medical Center, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
  • Coeckelenbergh S; Department of Anesthesiology, Université Paris-Saclay, Hôpital Paul-Brousse, Assistance Publique Hôpitaux de Paris, Villejuif, France.
  • Pochard J; Outcomes Research Consortium, Cleveland, OH, USA.
  • Vicaut E; Department of Intensive Care, Université Paris-Saclay, Hôpital Bicetre, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicetre, France.
  • Duranteau J; Unité de Recherche Clinique, Lariboisière University Hospital, Paris 7 Diderot University, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
J Clin Monit Comput ; 38(1): 25-30, 2024 02.
Article in En | MEDLINE | ID: mdl-38310591
ABSTRACT
Brain injury patients require precise blood pressure (BP) management to maintain cerebral perfusion pressure (CPP) and avoid intracranial hypertension. Nurses have many tasks and norepinephrine titration has been shown to be suboptimal. This can lead to limited BP control in patients that are in critical need of cerebral perfusion optimization. We have designed a closed-loop vasopressor (CLV) system capable of maintaining mean arterial pressure (MAP) in a narrow range and we aimed to assess its performance when treating severe brain injury patients. Within the first 48 h of intensive care unit (ICU) admission, 18 patients with a severe brain injury underwent either CLV or manual norepinephrine titration. In both groups, the objective was to maintain MAP in target (within ± 5 mmHg of a predefined target MAP) to achieve optimal CPP. Fluid administration was standardized in the two groups. The primary objective was the percentage of time patients were in target. Secondary outcomes included time spent over and under target. Over the four-hour study period, the mean percentage of time with MAP in target was greater in the CLV group than in the control group (95.8 ± 2.2% vs. 42.5 ± 27.0%, p < 0.001). Severe undershooting, defined as MAP < 10 mmHg of target value was lower in the CLV group (0.2 ± 0.3% vs. 7.4 ± 14.2%, p < 0.001) as was severe overshooting defined as MAP > 10 mmHg of target (0.0 ± 0.0% vs. 22.0 ± 29.0%, p < 0.001). The CLV system can maintain MAP in target better than nurses caring for severe brain injury patients.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Brain Injuries / Norepinephrine Type of study: Clinical_trials Limits: Humans Language: En Journal: J Clin Monit Comput / J. clin. monit. comput / Journal of clinical monitoring and computing Journal subject: INFORMATICA MEDICA / MEDICINA Year: 2024 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Brain Injuries / Norepinephrine Type of study: Clinical_trials Limits: Humans Language: En Journal: J Clin Monit Comput / J. clin. monit. comput / Journal of clinical monitoring and computing Journal subject: INFORMATICA MEDICA / MEDICINA Year: 2024 Document type: Article Affiliation country: Country of publication: