Title of article :
Side Effects of Indomethacin in Refractory Post-traumatic Intracranial Hypertension: A Comprehensive Case Study and Review
Author/Authors :
Agustín Godoy, Daniel Intensive Care Unit - San Juan Bautista Hospital, Catamarca, Argentina , Guerrero Suarez, Pablo David Department of Neurosurgery - ISSEMyM Medical Center, Toluca, México , Moscote-Salazar, Luis Rafael Intensive Care Unit - University Clinic, Puerto Montt, Chile , Di Napoli, Mario Neurological Service - San Camillo de’ Lellis General Hospital, Rieti, Italy
Abstract :
Intracranial hypertension (IH) is one of the final pathways of acute brain injury. In severe traumatic brain injury (sTBI), it independently predicts poor outcomes. Its control represents a key aspect of the management. Lack of response to conventional therapies signals a state of ‘’refractory IH’’, with an associated mortality rate of 80-100%. In such cases, hypothermia, barbiturates at high doses (BBT), decompressive craniectomy (DC), and extreme hyperventilation are utilized. However, none of them has proven efficacy. Indomethacin (INDO), a non-steroidal anti-inflammatory drug, may be an option with an acceptable safety profile and easy to administer. Reported series showed encouraging results. We herein present a case of refractory IH after sTBI in which INDO was utilized. In refractory IH, INDO can help to decrease ICP and improve cerebral perfusion pressure. However, it requires administration under strict protocol since it’s not free of adverse effects after withdrawal.
Keywords :
Indomethacin , Traumatic brain injury (TBI) , Refractory intracranial hypertension , Cerebral blood flow , Rebound effect , Side effects
Journal title :
Bulletin of Emergency and Trauma
