Pre-injury beta blocker use does not affect the hyperdynamic response in older trauma patients
| Autor: | Anthony T Gerlach, Stanislaw P Stawicki, Andrei Radulescu, Daniel S. Eiferman, Thomas J Papadimos, Kendrick M Khoo, David C. Evans, Charles H. Cook, Steven M. Steinberg |
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| Rok vydání: | 2014 |
| Předmět: |
hyperdynamic response
medicine.medical_specialty medicine.drug_class business.industry cardiac medication lcsh:Medical emergencies. Critical care. Intensive care. First aid Diastole Poison control lcsh:RC86-88.9 Calcium channel blocker Amiodarone Surgery Beta-blockers Blood pressure Internal medicine Cardiovascular agent Emergency Medicine medicine Cardiology Injury Severity Score Original Article geriatric trauma business Beta blocker medicine.drug |
| Zdroj: | Journal of Emergencies, Trauma, and Shock Journal of Emergencies, Trauma and Shock, Vol 7, Iss 4, Pp 305-309 (2014) |
| ISSN: | 0974-2700 |
| Popis: | PURPOSE: Trauma dogma dictates that the physiologic response to injury is blunted by beta-blockers and other cardiac medications. We sought to determine how the pre-injury cardiac medication profile influences admission physiology and post-injury outcomes. MATERIALS AND METHODS: Trauma patients older than 45 evaluated at our center were retrospectively studied. Pre-injury medication profiles were evaluated for angiotensin-converting enzyme inhibitors / angiotensin receptor blockers (ACE-I/ARB), beta-blockers, calcium channel blockers, amiodarone, or a combination of the above mentioned agents. Multivariable logistic regression or linear regression analyses were used to identify relationships between pre-injury medications, vital signs on presentation, post-injury complications, length of hospital stay, and mortality. RESULTS: Records of 645 patients were reviewed (mean age 62.9 years, Injury Severity Score >10, 23%). Our analysis demonstrated no effect on systolic and diastolic blood pressures from beta-blocker, ACE-I/ARB, calcium channel blocker, and amiodarone use. The triple therapy (combined beta-blocker, calcium channel blocker, and ACE-I/ARB) patient group had significantly lower heart rate than the no cardiac medication group. No other groups were statistically different for heart rate, systolic, and diastolic blood pressure. CONCLUSIONS: Pre-injury use of cardiac medication lowered heart rate in the triple-agent group (beta-blocker, calcium channel blocker, and ACEi/ARB) when compared the no cardiac medication group. While most combinations of cardiac medications do not blunt the hyperdynamic response in trauma cases, patients on combined beta-blocker, calcium channel blocker, and ACE-I/ARB therapy had higher mortality and more in-hospital complications despite only mild attenuation of the hyperdynamic response. Language: en |
| Databáze: | OpenAIRE |
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