中度至重度创伤性脑损伤重症患者早期使用β受体阻滞剂与功能预后的关联：创伤性脑损伤研究中的临床研究与知识转化
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.
作者信息
Kelly-Hedrick Margot, Liu Sunny Yang, Temkin Nancy, Barber Jason, Komisarow Jordan, Manley Geoffrey, Ohnuma Tetsu, Colton Katharine, Treggiari Miriam M, Monson Eric E, Vavilala Monica S, Grandhi Ramesh, Laskowitz Daniel T, Mathew Joseph P, Hernandez Adrian, James Michael L, Raghunathan Karthik, Goldstein Ben, Markowitz Amy J, Krishnamoorthy Vijay
机构信息
Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, NC.
Duke University School of Medicine, Duke University, Durham, NC.
出版信息
Crit Care Explor. 2023 Sep 5;5(9):e0958. doi: 10.1097/CCE.0000000000000958. eCollection 2023 Sep.
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.
目的
我们旨在1）描述中重度创伤性脑损伤（TBI）后重症患者使用β受体阻滞剂的模式，以及2）研究早期暴露于β受体阻滞剂与损伤后功能和临床结局之间的关联。
设计
回顾性队列研究。
地点
美国18家一级创伤中心的重症监护病房，参与创伤性脑损伤临床研究与知识转化（TRACK-TBI）研究。
患者
年龄大于或等于17岁，参与TRACK-TBI研究且患有中重度TBI（格拉斯哥昏迷量表<13），因钝性TBI入住重症监护病房。
干预措施
无。
测量指标
主要暴露因素为入住重症监护病房的前7天内使用β受体阻滞剂，主要结局指标为6个月时的扩展格拉斯哥预后量表（GOSE）。次要结局指标包括：住院时间、院内死亡率、6个月和12个月死亡率、12个月GOSE评分，以及6个月和12个月时的残疾、幸福感、生活质量和生活满意度测量指标。
主要结果
在450名符合条件的参与者中，57名（13%）接受了早期β受体阻滞剂治疗（β受体阻滞剂组）。β受体阻滞剂组平均年龄更大，更有可能在受伤前使用β受体阻滞剂，且更有可能有高血压病史。在β受体阻滞剂组中，34名参与者（60%）仅接受美托洛尔治疗，19名参与者（33%）仅接受普萘洛尔治疗，3名参与者（5%）同时接受两者治疗，1名参与者（2%）仅接受阿替洛尔治疗。在多变量回归分析中，β受体阻滞剂组与非β受体阻滞剂组在6个月时GOSE评分较高的几率上没有差异（优势比=0.86；95%置信区间，0.48-1.53）。β受体阻滞剂暴露与次要结局之间没有关联。
结论
在我们的研究中，约六分之一的受试者接受了早期β受体阻滞剂治疗，在该组中，β受体阻滞剂的剂量和给药时间差异很大。尽管与先前的研究相比，我们得出结论的能力受到总体给药总剂量较低的限制，但6个月时GOSE评分没有显著差异。
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