Clinical scienceBeta-blocker exposure in the absence of significant head injuries is associated with reduced mortality in critically ill patients
Section snippets
Methods
After approval by the institutional review board, we retrospectively reviewed all trauma patients admitted to the Los Angeles County + University of Southern California Medical Center surgical intensive care unit (SICU) from January 2000 to December 2008. Patients sustaining moderate to severe head injuries, defined as a head Abbreviated Injury Score (AIS) ≥ 3, were excluded.
Demographic and clinical information collected included age, gender, mechanism of injury (blunt vs penetrating), blood
Results
During the 9-year study period, 5,180 patients were admitted to the SICU. After the exclusion of 2,231 patients with moderate to severe head injuries (head AIS ≥ 3), 663 patients with ISS ≥ 25 and 2,286 patients with ISS < 25 were available for analysis (Fig. 1). Beta-blocker exposure was consistent across both populations, with 14.8% of patients with ISS ≥ 25 and 15.1% of those with ISS < 25 exposed during the first 30 days of SICU admission.
Table 1 compares the demographic and clinical injury
Comments
The role of catecholamines in critical illness was established in the early 1900s,27 and modulation of this response has been an area of intense research investigation in the past decade. Severe injury is associated with sympathetic hyperactivity due to an exaggerated catecholamine response that has been shown to have a positive relationship to ISS.6 Many deleterious effects of the catecholamine surge are mediated through the β-adrenergic receptor, regardless of the source of insult.27
Conclusions
Our study suggests that there is another trauma population that may benefit from β-adrenergic blockade. In patients sustaining severe injuries, as defined by ISS ≥ 25, in the absence of significant head injuries, β-blocker exposure appears to be associated with a mortality benefit and may offer a simple therapeutic intervention. The protective mechanism of β-blocker administration remains to be elucidated given the multiple systemic effects of catecholamines and their respective β-receptors.
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