Noradrenaline for Severe Traumatic Brain Injury

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Claudia please give us some evidence for your point 3. There is none to my knowledge.
We use noradrenaline routinely for brain dead organ donors.
My reading to date: there is no clinical evidence at all to support a choice of adrenaline vs noradrenaline [three studies underway internationally, the St George CAT study in Sydney, Annane's CATS study and the SOAP study] so use whichever you are comfortable with. However there is very GOOD evidence of harm from dopamine (adverse neuroendocrine effects starting from Greet van den Berghe's PhD work and going from there). The only place for dopamine is in Dr Mattox's museum.

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Staff Specialist in Intensive Care Medicine
The Nepean Hospital, 
PO Box 63, Penrith NSW 2751
Clinical Lecturer, University of Sydney


>>> glamourcv at gmail.com 3/02/2006 2:00pm >>>
I certainly agree on this one.
(1) noradrenalin infusion is ideally performed in a central venous
access - in trauma, peripheral venous access is advisable.
(2) variations in ABP happen faster than dopamine. An accidental
noradrenaline flush can cause a lot of damage. Dopamine seems to be 
safer in this aspect. Noradrenaline without direct  MAP monitoring is
not a good idea...
(3) noradrenalin is terrible for possible donors, it´s bad for
splancnic perfusion (kidney and liver...) and also is detrimental for
heart donation


is it not enough to use it only as a second line drug???

claudia

On 2/2/06, Hardcastle Tim, Dr <tch at sun.ac.za> <tch at sun.ac.za> wrote:
> Dr Wolfer
>
> Still does not make it suitable for trauma - first stop the bleeding then
> add the drugs etc. More at a basic science level: If the patient with a
> major head injruy and no source of bleeding is hypotensive then you either
> have a high spinal cord injury or a pre-mortality response to a major head
> injury; both of the latter carry a significant less than one month
> mortality. What I'm saying is - is it all worth it; unless you have the
> donor team standing by???
>
> Tim
> Dr T C Hardcastle
> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
> Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
> ATLS  instructor and DSTC Cape Town Course Director
> Intern program Coordinator: Surgery
> Program Manager: Emergency Medicine (U.S.)
> Clinical Head (Director): Diana Princess of Wales Trauma Unit
> Department of Surgery Room 4064
> Tygerberg Hospital / University of Stellenbosch
> PO Box 19063
> Tygerberg 7505
> Western Cape
> South Africa
>
> 2 Lorient Close
> Vredekloof, Brackenfell
> 7560, Western Cape,
> South Africa
> e-mail: tch at sun.ac.za 
> Cell: +27824681615
> Office: +27219389281 or 4911 pager 0302
> Home: +27219813098
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org]On Behalf Of RWolfer at aol.com 
> Sent: Thursday, February 02, 2006 1:31 AM
> To: trauma-list at trauma.org 
> Subject: Re: Noradrenaline for Severe Traumatic Brain Injury
>
>
> There are now several studies that show that Levophed is a better pressor
> than dopamine .  It is better at improving pressure, renal blood flow and
> urine
> output.  There was a very recent study in Chest. RW
> --
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