Brain Sciences (Jan 2024)

The Impact of Inotropes and Vasopressors on Cerebral Oxygenation in Patients with Traumatic Brain Injury and Subarachnoid Hemorrhage: A Narrative Review

  • Michele Salvagno,
  • Federico Geraldini,
  • Giacomo Coppalini,
  • Chiara Robba,
  • Elisa Gouvea Bogossian,
  • Filippo Annoni,
  • Eva Vitali,
  • Elda Diletta Sterchele,
  • Costantino Balestra,
  • Fabio Silvio Taccone

DOI
https://doi.org/10.3390/brainsci14020117
Journal volume & issue
Vol. 14, no. 2
p. 117

Abstract

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Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are critical neurological conditions that necessitate specialized care in the Intensive Care Unit (ICU). Managing cerebral perfusion pressure (CPP) and mean arterial pressure (MAP) is of primary importance in these patients. To maintain targeted MAP and CPP, vasopressors and/or inotropes are commonly used. However, their effects on cerebral oxygenation are not fully understood. The aim of this review is to provide an up-to date review regarding the current uses and pathophysiological issues related to the use of vasopressors and inotropes in TBI and SAH patients. According to our findings, despite achieving similar hemodynamic parameters and CPP, the effects of various vasopressors and inotropes on cerebral oxygenation, local CBF and metabolism are heterogeneous. Therefore, a more accurate understanding of the cerebral activity of these medications is crucial for optimizing patient management in the ICU setting.

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