Introduction: Protocols for sedative drugs in patients with severe head traumatic brain injury have not been established. The purpose of this study was to investigate sedatives based on target temperature management (TTM).
Subjects and Methods: Data from 1345 patients were obtained from the Japan Neurotrauma Data Bank Project 2015, a cohort observational study. Patients with non–active treatment at trauma resuscitation, cardiac arrest, or no medical treatment were excluded, leaving 787 patients in this study. The use of neuro–intensive drugs including sedatives, analgesic and neuromuscular blocking drugs (NMBDs) in adults and children was examined. The patients were divided into three groups: (1) the non–temperature control (NC) group treated with no TTM; (2) the aggressive normothermia therapy (NT) group treated with aggressive normothermia group; and (3) the mild hypothermia therapy (HT) group with mild hypothermia management. We compared the sedatives, analgesia, and NMBDs in the three groups.
Results: For sedatives, propofol (PROP) was often used in 45% in adults. Midazolam (MDZ) and dexmedetomidine (DEX) are more commonly used in pediatric compared with adult patients (p<0.001, 0.04). Two or more sedatives were administered in 15% of adults and 12% pediatric patients. In adults, DEX was often administered in the NT group, and MDZ in the HT group. Analgesics was used in 53% of NT and 73% of HT patients. NMBDs were used for 10% of NT and 40% of HT patients.
Conclusion: Currently, neuro–intensive care such as TTM that is based on the pathological condition has become common, and it is necessary to also show the optimal protocol in for sedative management of severe traumatic brain injuries.
