Beta-Blocker Use is Associated With Improved Outcomes in Adult Trauma Patients
- 1 January 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Journal of Trauma and Acute Care Surgery
- Vol. 62 (1), 56-62
- https://doi.org/10.1097/ta.0b013e31802d972b
Abstract
Background: Beta-adrenoreceptor blocker (β-blocker) therapy may improve outcomes in surgical patients by decreasing cardiac oxygen consumption and hypermetabolism. Because β-blockers can lower the systemic blood pressure and cerebral perfusion pressure, there is concern regarding their use in patients with head injury. However, β-blockers may protect β-receptor rich brain cells by attenuating cerebral oxygen consumption and metabolism. We hypothesized that β-blockers are safe in trauma patients, even if they have suffered a significant head injury. Methods: Using pharmacy and trauma registry data of a Level I trauma center, we identified a cohort of trauma patients who received β-blockers during their hospital stay (β-cohort). Trauma admissions who did not receive β-blockers were in the control cohort. β-blocker status, in combination with other variables associated with mortality, were placed in a stepwise multivariate logistic regression to identify independent predictors of fatal outcome. Results: In all, 303 (7%) of 4,117 trauma patients received β-blockers. In the β-cohort, 45% of patients were on β-blockers preinjury. The most common reason to initiate β-blocker therapy was blood pressure (60%) and heart rate (20%) control. The overall mortality rate was 5.6% and head injury was considered to be the major cause of death. After adjusting for age, Injury Severity Scale score, blood pressure, Glasgow Coma Scale score, respiratory status, and mechanism of injury, the odds ratio for fatal outcome was 0.3 (p < 0.001) for β-cohort as compared with control. Decreased risk of fatal outcome was more pronounced in patients with a significant head injury. Conclusions: β-blocker therapy is safe and may be beneficial in selected trauma patients with or without head injury. Further studies looking at β-blocker therapy in trauma patients and their effect on cerebral metabolism are warranted.Keywords
This publication has 32 references indexed in Scilit:
- Beta-Blocker Use Is Associated with Improved Outcomes in Adult Burn PatientsThe Journal of Trauma and Acute Care Surgery, 2004
- Activation-Induced Resetting of Cerebral Metabolism and Flow Is Abolished by β-Adrenergic Blockade With PropranololStroke, 2002
- Reversal of Catabolism by Beta-Blockade after Severe BurnsThe New England Journal of Medicine, 2001
- Catecholamines play a role in the production of interleukin-6 and interleukin-1α in unburned skin after burn injury in miceCritical Care Medicine, 2001
- Aspects on the cerebral perfusion pressure during therapy of a traumatic head injuryActa Anaesthesiologica Scandinavica, 1997
- EditorialJournal of Neurotrauma, 1996
- Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension in the Adult US PopulationHypertension, 1995
- Effects of propranolol pretreatment on cerebral blood flow, oxygen uptake and catecholamines during metabolic acidosis followingE. coliendotoxin in dogsActa Anaesthesiologica Scandinavica, 1995
- Effects of hypotensive treatment with α2‐agonist and β1‐antagonist on cerebral haemodynamics in severely head injured patientsActa Anaesthesiologica Scandinavica, 1995
- Effect of Propranolol Administration on Hemodynamic and Metabolic Responses of Burned Pediatric PatientsAnnals of Surgery, 1988