Effectiveness of Beta-blocker Use in Patients with Severe Traumatic Brain Injury: A Systematic Review and Meta-analysis
Micah Ngatuvai1, *Adel Elkbuli2
1Department of Surgery, Orlando Regional Medical Center, Orlando, FL; 2Orlando Regional Medical Center, Orlando, FL
Background (issue): Traumatic brain injury (TBI), a leading cause of morbidity and mortality among trauma patients worldwide, poses the risk of secondary neurological insult due to significant catecholamine surge. Beta-adrenergic blockade to attenuate levels of circulating catecholamines and the sympathetic cascade has been associated with decreased severity of brain injury, reduced in-hospital mortality, and improved functional outcomes in patients with severe TBI.
Methods: A search through PubMed, EMBASE, JAMA network, and Google Scholar databases was conducted for relevant peer-reviewed original studies published before February 15, 2022. A standard random effects model was used, as justified by a high Cohen’s Q test.
Findings: Twelve studies met inclusion criteria and were included in the meta-analysis. Severe TBI patients who received beta-blockers had a significantly reduced incidence of in-hospital mortality compared to the non-beta-blocker group (14.5% vs 19.2%). However, the beta-blocker group was reported to have a significantly greater number of ventilator days (5.58 vs. 2.60 days). Similarly, intensive care unit (9.00 vs. 6.84 days) and hospital (17.30 vs. 11.02 days) lengths of stay (LOS) were increased in the beta-blocker group compared to those who did not receive beta-blocker therapy, but only the difference in hospital-LOS was significant.
Conclusions (implications for practice): Beta-blockers have significant survival benefits in patients with severe TBI despite being associated with an increase in ventilator days and hospital-LOS. The utilization of beta-blocker therapy in the management of severe TBI may be warranted and should be discussed in future guidelines. Further exploration of the functional outcomes associated with beta-blocker therapy and the potential benefits of beta-adrenergic blockage among patients with mild and moderate TBI may assist future clinical recommendations.
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