Prostacyclin in trauma patients with hemorrhagic shock: A randomized clinical trial
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Standard
Prostacyclin in trauma patients with hemorrhagic shock : A randomized clinical trial. / Johansson, Pär I.; Eriksen, Christian Fenger; Bovbjerg, Pernille E.; Gaarder, Christine; Pall, Marlene; Henriksen, Hanne Hee; Pedersen, Kristine H.; Vigstedt, Martin; Lange, Theis; Næss, Pål Aksel; Strømgaard Andersen, Mikkel; Kirkegaard, Hans; Stensballe, Jakob.
I: Journal of Trauma and Acute Care Surgery, Bind 96, Nr. 3, 2024, s. 476-481.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Prostacyclin in trauma patients with hemorrhagic shock
T2 - A randomized clinical trial
AU - Johansson, Pär I.
AU - Eriksen, Christian Fenger
AU - Bovbjerg, Pernille E.
AU - Gaarder, Christine
AU - Pall, Marlene
AU - Henriksen, Hanne Hee
AU - Pedersen, Kristine H.
AU - Vigstedt, Martin
AU - Lange, Theis
AU - Næss, Pål Aksel
AU - Strømgaard Andersen, Mikkel
AU - Kirkegaard, Hans
AU - Stensballe, Jakob
N1 - Publisher Copyright: © Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024
Y1 - 2024
N2 - BACKGROUND A main cause of trauma morbidity and mortality is multiple-organ failure, and endotheliopathy has been implicated. Pilot studies indicate that low-dose prostacyclin improves endothelial functionality in critically ill patients, suggesting that this intervention may improve trauma patient outcome. METHODS We conducted a multicenter, randomized, blinded, clinical investigator-initiated trial in 229 trauma patients with hemorrhagic shock who were randomized 1:1 to 72 hours infusion of the prostacyclin analog iloprost (1 ng/kg/min) or placebo. The primary outcome was the number of intensive care unit (ICU)-free days alive within 28 days of admission. Secondary outcomes included 28-day all-cause mortality and hospital length of stay. RESULTS The mean number of ICU-free days alive within 28 days was 15.64 days in the iloprost group versus 13.99 days in the placebo group (adjusted mean difference, -1.63 days [95% confidence interval (CI), -4.64 to 1.38 days]; p = 0.28). The 28-day mortality was 18.8% in the iloprost group versus 19.6% in the placebo group (odds ratio, 1.01 [95% CI, 0.51-2.0]; p = 0.97). The mean hospital length of stay was 19.96 days in the iloprost group versus 27.32 days in the placebo group (adjusted mean difference, 7.84 days [95% CI, 1.66-14.02 days], p = 0.01). CONCLUSION Iloprost did not result in a statistically significant increase in the number of ICU-free days alive within 28 days of admission, whereas it was safe and a statistically significant reduction in hospital length of stay was observed. Further research on prostacyclin in shocked trauma patients is warranted. LEVEL OF EVIDENCE Therapeutic/Care Management; Level II.
AB - BACKGROUND A main cause of trauma morbidity and mortality is multiple-organ failure, and endotheliopathy has been implicated. Pilot studies indicate that low-dose prostacyclin improves endothelial functionality in critically ill patients, suggesting that this intervention may improve trauma patient outcome. METHODS We conducted a multicenter, randomized, blinded, clinical investigator-initiated trial in 229 trauma patients with hemorrhagic shock who were randomized 1:1 to 72 hours infusion of the prostacyclin analog iloprost (1 ng/kg/min) or placebo. The primary outcome was the number of intensive care unit (ICU)-free days alive within 28 days of admission. Secondary outcomes included 28-day all-cause mortality and hospital length of stay. RESULTS The mean number of ICU-free days alive within 28 days was 15.64 days in the iloprost group versus 13.99 days in the placebo group (adjusted mean difference, -1.63 days [95% confidence interval (CI), -4.64 to 1.38 days]; p = 0.28). The 28-day mortality was 18.8% in the iloprost group versus 19.6% in the placebo group (odds ratio, 1.01 [95% CI, 0.51-2.0]; p = 0.97). The mean hospital length of stay was 19.96 days in the iloprost group versus 27.32 days in the placebo group (adjusted mean difference, 7.84 days [95% CI, 1.66-14.02 days], p = 0.01). CONCLUSION Iloprost did not result in a statistically significant increase in the number of ICU-free days alive within 28 days of admission, whereas it was safe and a statistically significant reduction in hospital length of stay was observed. Further research on prostacyclin in shocked trauma patients is warranted. LEVEL OF EVIDENCE Therapeutic/Care Management; Level II.
KW - hemorrhagic shock-induced endotheliopathy
KW - prostacyclin
KW - randomized clinical trial
KW - Trauma
U2 - 10.1097/TA.0000000000004150
DO - 10.1097/TA.0000000000004150
M3 - Journal article
C2 - 37962189
AN - SCOPUS:85185715547
VL - 96
SP - 476
EP - 481
JO - Journal of Trauma
JF - Journal of Trauma
SN - 2163-0755
IS - 3
ER -
ID: 384656538