Parenteral diclofenac infusion significantly decreases brain-tissue oxygen tension in patients with poor-grade aneurysmal subarachnoid hemorrhage

Diclofenac, a nonsteroidal antiinflammatory drug, is commonly used as antipyretic therapy in intensive care. The purpose of this study was to investigate the effects of parenteral diclofenac infusion on brain homeostasis, including brain-tissue oxygen tension (PbtO2) and brain metabolism after aneur...

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Bibliographic Details
Published in:Critical care (London, England) England), 2013-05, Vol.17 (3), p.R88-R88
Main Authors: Schiefecker, Alois J, Pfausler, Bettina, Beer, Ronny, Sohm, Florian, Sabo, Jan, Knauseder, Viktoria, Fischer, Marlene, Dietmann, Anelia, Hackl, Werner O, Thomé, Claudius, Schmutzhard, Erich, Helbok, Raimund
Format: Article
Language:English
Subjects:
Anti-Inflammatory Agents, Non-Steroidal - administration & dosage
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Blood Pressure - drug effects
Body Temperature - drug effects
Brain - metabolism
Cerebrovascular Circulation - drug effects
Complications and side effects
Diclofenac
Diclofenac - administration & dosage
Diclofenac - therapeutic use
Dosage and administration
Drug therapy
Humans
Infusions, Parenteral
Intracranial Pressure - drug effects
Monitoring, Physiologic
Oxygen - metabolism
Prevention
Prospective Studies
Retrospective Studies
Subarachnoid hemorrhage
Subarachnoid Hemorrhage - drug therapy
Subarachnoid Hemorrhage - metabolism
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Summary:Diclofenac, a nonsteroidal antiinflammatory drug, is commonly used as antipyretic therapy in intensive care. The purpose of this study was to investigate the effects of parenteral diclofenac infusion on brain homeostasis, including brain-tissue oxygen tension (PbtO2) and brain metabolism after aneurysmal subarachnoid hemorrhage (aSAH). We conducted a prospective, observational study with retrospective analysis of 21 consecutive aSAH patients with multimodal neuromonitoring. Cerebral perfusion pressure (CPP), mean arterial pressure (MAP), intracranial pressure (ICP), body temperature, and PbtO2 were analyzed after parenteral diclofenac infusion administered over a 34-minute period (20 to 45 IQR). Data are given as mean ± standard error of mean and median with interquartile range (IQR), as appropriate. Time-series data were analyzed by using a general linear model extended by generalized estimation equations (GEEs). One-hundred twenty-three interventions were analyzed. Body temperature decreased from 38.3°C ± 0.05°C by 0.8°C ± 0.06°C (P < 0.001). A 10% decrease in MAP and CPP (P < 0.001) necessitated an increase of vasopressors in 26% (n = 32), colloids in 33% (n = 41), and crystalloids in 5% (n = 7) of interventions. PbtO2 decreased by 13% from a baseline value of 28.1 ± 2.2 mm Hg, resulting in brain-tissue hypoxia (PbtO2
ISSN:1364-8535
1466-609X
DOI:10.1186/cc12714