Association of Early Beta-Blocker Exposure and Functional Outcomes in Critically Ill Patients With Moderate to Severe Traumatic Brain Injury: A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study

Margot Kelly-Hedrick, MBE; Sunny Yang Liu, BA; Nancy Temkin, PhD; Jason Barber, MS; Jordan Komisarow, MD; Geoffrey Manley, MD, PhD; Tetsu Ohnuma, MD, MPH, PhD; Katharine Colton, MD; Miriam M. Treggiari, MD, MPH, PhD; Eric E. Monson, PhD; Monica S. Vavilala, MD; Ramesh Grandhi, MD, MS; Daniel T. Laskowitz, MD, MHS; Joseph P. Mathew, MD, MHS, MBA; Adrian Hernandez, MD, MHS; Michael L. James, MD; Karthik Raghunathan, MD, MPH; Ben Goldstein, PhD; Amy J. Markowitz, JD; Vijay Krishnamoorthy, MD, MPH, PhD; the Transforming Clinical Research and Knowledge in Traumatic Brain Injury Investigators; Neeraj Badjatia, MD; Adam R. Ferguson, PhD; Brandon Foreman, MD; Michael McCrea, PhD; Randall Merchant, PhD; Laura B. Ngwenya, MD, PhD; David Okonkwo, MD, PhD; David Schnyer, PhD; John K. Yue, MD; Ross Zafonte, DO

doi:10.1097/CCE.0000000000000958

Critical Care Explorations (Sep 2023)

Association of Early Beta-Blocker Exposure and Functional Outcomes in Critically Ill Patients With Moderate to Severe Traumatic Brain Injury: A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study

Margot Kelly-Hedrick, MBE,
Sunny Yang Liu, BA,
Nancy Temkin, PhD,
Jason Barber, MS,
Jordan Komisarow, MD,
Geoffrey Manley, MD, PhD,
Tetsu Ohnuma, MD, MPH, PhD,
Katharine Colton, MD,
Miriam M. Treggiari, MD, MPH, PhD,
Eric E. Monson, PhD,
Monica S. Vavilala, MD,
Ramesh Grandhi, MD, MS,
Daniel T. Laskowitz, MD, MHS,
Joseph P. Mathew, MD, MHS, MBA,
Adrian Hernandez, MD, MHS,
Michael L. James, MD,
Karthik Raghunathan, MD, MPH,
Ben Goldstein, PhD,
Amy J. Markowitz, JD,
Vijay Krishnamoorthy, MD, MPH, PhD,
the Transforming Clinical Research and Knowledge in Traumatic Brain Injury Investigators,
Neeraj Badjatia, MD,
Adam R. Ferguson, PhD,
Brandon Foreman, MD,
Michael McCrea, PhD,
Randall Merchant, PhD,
Laura B. Ngwenya, MD, PhD,
David Okonkwo, MD, PhD,
David Schnyer, PhD,
John K. Yue, MD,
Ross Zafonte, DO

Affiliations

Margot Kelly-Hedrick, MBE: 1 Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, NC.
Sunny Yang Liu, BA: 1 Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, NC.
Nancy Temkin, PhD: 3 Departments of Biostatistics, University of Washington, Seattle, WA.
Jason Barber, MS: 4 Departments of Neurosurgery, University of Washington, Seattle, WA.
Jordan Komisarow, MD: 5 Departments of Neurosurgery, Duke University, Durham, NC.
Geoffrey Manley, MD, PhD: 6 Departments of Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA.
Tetsu Ohnuma, MD, MPH, PhD: 1 Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, NC.
Katharine Colton, MD: 8 Departments of Neurology, Duke University, Durham, NC.
Miriam M. Treggiari, MD, MPH, PhD: 1 Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, NC.
Eric E. Monson, PhD: 10 Libraries Center for Data and Visualization Sciences, Duke University, Durham, NC.
Monica S. Vavilala, MD: 11 Departments of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Ramesh Grandhi, MD, MS: 12 Department of Neurosurgery, University of Utah, Salt Lake City, UT.
Daniel T. Laskowitz, MD, MHS: 5 Departments of Neurosurgery, Duke University, Durham, NC.
Joseph P. Mathew, MD, MHS, MBA: 7 Departments of Anesthesiology, Duke University, Durham, NC.
Adrian Hernandez, MD, MHS: 13 Departments of Medicine, Duke University, Durham, NC.
Michael L. James, MD: 1 Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, NC.
Karthik Raghunathan, MD, MPH: 1 Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, NC.
Ben Goldstein, PhD: 14 Departments of Biostatistics and Bioinformatics, Duke University, Durham, NC.
Amy J. Markowitz, JD: 6 Departments of Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA.
Vijay Krishnamoorthy, MD, MPH, PhD: 1 Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, NC.
the Transforming Clinical Research and Knowledge in Traumatic Brain Injury Investigators
Neeraj Badjatia, MD
Adam R. Ferguson, PhD
Brandon Foreman, MD
Michael McCrea, PhD
Randall Merchant, PhD
Laura B. Ngwenya, MD, PhD
David Okonkwo, MD, PhD
David Schnyer, PhD
John K. Yue, MD
Ross Zafonte, DO

DOI: https://doi.org/10.1097/CCE.0000000000000958
Journal volume & issue: Vol. 5, no. 9
p. e0958

Abstract

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OBJECTIVES:. We aimed to 1) describe patterns of beta-blocker utilization among critically ill patients following moderate–severe traumatic brain injury (TBI) and 2) examine the association of early beta-blocker exposure with functional and clinical outcomes following injury. DESIGN:. Retrospective cohort study. SETTING:. ICUs at 18 level I, U.S. trauma centers in the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study. PATIENTS:. Greater than or equal to 17 years enrolled in the TRACK-TBI study with moderate–severe TBI (Glasgow Coma Scale of <13) were admitted to the ICU after a blunt TBI. INTERVENTIONS:. None. MEASUREMENTS:. Primary exposure was a beta blocker during the first 7 days in the ICU, with a primary outcome of 6-month Glasgow Outcome Scale-Extended (GOSE). Secondary outcomes included: length of hospital stay, in-hospital mortality, 6-month and 12-month mortality, 12-month GOSE score, and 6-month and 12-month measures of disability, well-being, quality of life, and life satisfaction. MAIN RESULTS:. Of the 450 eligible participants, 57 (13%) received early beta blockers (BB+ group). The BB+ group was on average older, more likely to be on a preinjury beta blocker, and more likely to have a history of hypertension. In the BB+ group, 34 participants (60%) received metoprolol only, 19 participants (33%) received propranolol only, 3 participants (5%) received both, and 1 participant (2%) received atenolol only. In multivariable regression, there was no difference in the odds of a higher GOSE score at 6 months between the BB+ group and BB– group (odds ratio = 0.86; 95% CI, 0.48–1.53). There was no association between BB exposure and secondary outcomes. CONCLUSIONS:. About one-sixth of subjects in our study received early beta blockers, and within this group, dose, and timing of beta-blocker administration varied substantially. No significant differences in GOSE score at 6 months were demonstrated, although our ability to draw conclusions is limited by overall low total doses administered compared with prior studies.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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