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Barbiturates for acute traumatic brain injury.

¹Department of Epidemiology, Institute of Child Health, 30 Guilford Street, London, UK, WC1N 1EH. Ian.roberts@ich.ucl.ac.uk

The Cochrane Database of Systematic Reviews

|May 5, 2000

Summary

Barbiturate therapy for acute severe head injury does not improve outcomes and can cause hypotension. This blood pressure drop may negate any potential benefits of lowering intracranial pressure (ICP).

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Area of Science:

Neuroscience
Critical Care Medicine
Pharmacology

Background:

Raised intracranial pressure (ICP) is a critical complication of severe brain injury, linked to high mortality.
Barbiturates are hypothesized to reduce ICP by suppressing cerebral metabolism, but may also decrease blood pressure, potentially impairing cerebral perfusion pressure.

Purpose of the Study:

To evaluate the efficacy of barbiturates in reducing elevated ICP, mortality, and morbidity in acute traumatic brain injury.
To quantify adverse effects associated with barbiturate use.

Main Methods:

Systematic review of randomized or quasi-randomized trials involving barbiturates for acute traumatic brain injury.
Searches of the Cochrane Library and other databases up to April 1999.
Data extraction and quality assessment of allocation concealment.

Main Results:

No significant difference in mortality (RR 1.09) or adverse neurological outcomes (RR 1.15) between barbiturate and non-barbiturate groups.
Barbiturates showed a trend towards reducing uncontrolled ICP (RR 0.81) but increased the risk of hypotension (RR 1.80).
Pentobarbital was less effective than mannitol in controlling ICP and associated with higher rates of requiring additional treatment.

Conclusions:

No evidence supports barbiturate therapy for improving outcomes in acute severe head injury.
Barbiturate-induced hypotension in 1 in 4 patients may counteract ICP-lowering effects on cerebral perfusion pressure.

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