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Jung E, Ro YS, Jeong J, Ryu HH, Shin SD. Alcohol intake before injury and functional and survival outcomes after traumatic brain injury: Pan-Asian trauma outcomes study (PATOS). Medicine (Baltimore) 2023; 102:e34560. [PMID: 37653804 PMCID: PMC10470812 DOI: 10.1097/md.0000000000034560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/19/2023] [Accepted: 07/12/2023] [Indexed: 09/02/2023] Open
Abstract
There are controversies about the effects of alcohol intake shortly before injury on prognosis of traumatic brain injury (TBI) patients. We investigated the association between alcohol intake and functional/survival outcomes in TBI patients, and whether this effect varied according to age and sex. This was a prospective international multicenter cohort study using the Pan-Asian trauma outcomes study registry in Asian-Pacific countries, conducted on adult patients with TBI who visited participating hospitals. The main exposure variable was alcohol intake before injury, and the main outcomes were poor functional recovery (modified Rankin Scale score, 4-6) and in-hospital mortality. Multivariable logistic regression analyses were conducted to estimate the effects of alcohol intake on study outcomes. Interaction analysis between alcohol intake and age/sex were also performed. Among the study population of 12,451, 3263 (26.2%) patients consumed alcohol before injury. In multivariable logistic regression analysis, alcohol intake was associated with lower odds for poor functional recovery [4.4% vs 6.6%, a odds ratio (95% confidence interval): 0.68 (0.56-0.83)] and in-hospital mortality (1.9% vs 3.1%, 0.64 [0.48-0.86]). The alcohol intake had interaction effects with sex for poor functional recovery: 0.59 (0.45-0.75) for male and 0.94 (0.60-1.49) for female (P for-interaction < .01), whereas there were no interaction between alcohol intake and age. In TBI patients, alcohol intake before injury was associated with lower odds of poor functional recovery and in-hospital mortality, and these effects were maintained in the male group in the interaction analyses.
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Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Joo Jeong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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Mayer AR, Dodd AB, Vermillion MS, Stephenson DD, Chaudry IH, Bragin DE, Gigliotti AP, Dodd RJ, Wasserott BC, Shukla P, Kinsler R, Alonzo SM. A systematic review of large animal models of combined traumatic brain injury and hemorrhagic shock. Neurosci Biobehav Rev 2019; 104:160-177. [PMID: 31255665 PMCID: PMC7307133 DOI: 10.1016/j.neubiorev.2019.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 01/08/2023]
Abstract
Traumatic brain injury (TBI) and severe blood loss (SBL) frequently co-occur in human trauma, resulting in high levels of mortality and morbidity. Importantly, each of the individual post-injury cascades is characterized by complex and potentially opposing pathophysiological responses, complicating optimal resuscitation and therapeutic approaches. Large animal models of poly-neurotrauma closely mimic human physiology, but a systematic literature review of published models has been lacking. The current review suggests a relative paucity of large animal poly-neurotrauma studies (N = 52), with meta-statistics revealing trends for animal species (exclusively swine), characteristics (use of single biological sex, use of juveniles) and TBI models. Although most studies have targeted blood loss volumes of 35-45%, the associated mortality rates are much lower relative to Class III/IV human trauma. This discrepancy may result from potentially mitigating experimental factors (e.g., mechanical ventilation prior to or during injury, pausing/resuming blood loss based on physiological parameters, administration of small volume fluid resuscitation) that are rarely associated with human trauma, highlighting the need for additional work in this area.
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Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM 87106, United States; Neurology Department, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States; Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States; Psychology Department, University of New Mexico, Albuquerque, NM 87131, United States.
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM 87106, United States
| | - Meghan S Vermillion
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM 87106, United States
| | - David D Stephenson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM 87106, United States
| | - Irshad H Chaudry
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0019, United States
| | - Denis E Bragin
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Andrew P Gigliotti
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM 87106, United States
| | - Rebecca J Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM 87106, United States
| | - Benjamin C Wasserott
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM 87106, United States
| | - Priyank Shukla
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM 87106, United States
| | - Rachel Kinsler
- Department of the Army Civilian, U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL 36362-0577, United States
| | - Sheila M Alonzo
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM 87106, United States
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Lusardi TA. Adenosine neuromodulation and traumatic brain injury. Curr Neuropharmacol 2010; 7:228-37. [PMID: 20190964 PMCID: PMC2769006 DOI: 10.2174/157015909789152137] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 05/18/2009] [Accepted: 05/20/2009] [Indexed: 12/17/2022] Open
Abstract
Adenosine is a ubiquitous signaling molecule, with widespread activity across all organ systems. There is evidence that adenosine regulation is a significant factor in traumatic brain injury (TBI) onset, recovery, and outcome, and a growing body of experimental work examining the therapeutic potential of adenosine neuromodulation in the treatment of TBI. In the central nervous system (CNS), adenosine (dys)regulation has been demonstrated following TBI, and correlated to several TBI pathologies, including impaired cerebral hemodynamics, anaerobic metabolism, and inflammation. In addition to acute pathologies, adenosine function has been implicated in TBI comorbidities, such as cognitive deficits, psychiatric function, and post-traumatic epilepsy. This review presents studies in TBI as well as adenosine-related mechanisms in co-morbidities of and unfavorable outcomes resulting from TBI. While the exact role of the adenosine system following TBI remains unclear, there is increasing evidence that a thorough understanding of adenosine signaling will be critical to the development of diagnostic and therapeutic tools for the treatment of TBI.
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Affiliation(s)
- T A Lusardi
- R. S. Dow Neurobiology Laboratory, Portland OR, USA.
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Rozin AP, Attias J, Presser D, Rosenberg H, Moscovitz M, Bentur Y. Alcohol Poisoning and Venous Hyperoxia. Toxicol Mech Methods 2008; 18:745-50. [DOI: 10.1080/15376510802364705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alexander P. Rozin
- The B. Shine Department of Rheumatology, Rambam Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Judith Attias
- Stat Laboratory, Rambam Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dita Presser
- Stat Laboratory, Rambam Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Helen Rosenberg
- Stat Laboratory, Rambam Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Marian Moscovitz
- Department of Emergency Medicine, Rambam Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yedidia Bentur
- Department of Toxicology, Rambam Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Plurad D, Demetriades D, Gruzinski G, Preston C, Chan L, Gaspard D, Margulies D, Cryer HG. Pedestrian Injuries: The Association of Alcohol Consumption with the Type and Severity of Injuries and Outcomes. J Am Coll Surg 2006; 202:919-27. [PMID: 16735206 DOI: 10.1016/j.jamcollsurg.2006.02.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Revised: 02/14/2006] [Accepted: 02/15/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Literature on the effect of alcohol ingestion on short-term outcomes for trauma patients shows conflicting results. We performed this study to investigate the prevalence of positive alcohol screens and the effect of alcohol level on injury patterns, injury severity, and outcomes in pedestrians and bicyclists involved in a collision with an automobile. STUDY DESIGN The study population included all pedestrians and bicyclists older than 10 years, treated in any of the 13 trauma centers in the Los Angeles County Emergency Services System during the calendar year 2003, who were involved in a collision with an automobile and had a blood alcohol level measured. The alcohol negative group was defined as those patients with a blood alcohol level </=0.05 g/dL. Low and high alcohol groups were defined as those having blood alcohol levels>0.05 g/dL to<0.08 g/dL and>/=0.08 g/dL, respectively. We compared the three study groups with respect to demographics, injury patterns, injury severity, complications, and outcomes. Logistic regression was used to determine if alcohol had an independent association with any outcomes. RESULTS There were 1,042 patients who met study criteria. Overall, 606 patients (58%) had a negative alcohol screen, 84 (8%) had low alcohol levels, and 352 (34%) had high alcohol levels. Alcohol level was not notably associated with severity of injury, admission hypotension, ICU length of stay, major complications, and injury pattern (head, chest, abdomen, or extremity Area Injury Score). Mortality was similar in the three alcohol level groups, but the overall complication rate and hospital length of stay were markedly higher in the high alcohol level group than they were in the negative alcohol level group. CONCLUSIONS In pedestrians and bicyclists involved in a collision with an automobile, a high alcohol level is not associated with body area severity of injury, overall severity of injury, and hospital mortality. But high alcohol level is notably associated with higher overall complication rate and longer hospital length of stay.
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Affiliation(s)
- David Plurad
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
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Choudhry MA, Ba ZF, Rana SN, Bland KI, Chaudry IH. Alcohol ingestion before burn injury decreases splanchnic blood flow and oxygen delivery. Am J Physiol Heart Circ Physiol 2004; 288:H716-21. [PMID: 15388502 DOI: 10.1152/ajpheart.00797.2004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recent studies from our laboratory have shown that alcohol and burn injury impair intestinal barrier and immune functions. Although multiple factors can contribute to impaired intestinal barrier function, such an alteration could result from a decrease in intestinal blood flow (BF) and oxygen delivery (DO2). Therefore, in this study, we tested the hypothesis that alcohol ingestion before burn injury reduces splanchnic blood flow and oxygen delivery. Rats (250 g) were gavaged with alcohol to achieve a blood ethanol level in the range of 100 mg/dl before burn or sham injury (25% total body surface area). Day 1 after injury, animals were anesthetized with methoxyflurane. Blood pressure, cardiac output (CO), +/-dP/dt, organ BF (in ml.min(-1).100 g(-1)), and DO2 (in mg.ml(-1).100 g(-1)) were determined. CO and organ BF were determined using a radioactive microsphere technique. Our results indicate that blood pressure, CO, and +dP/dt were decreased in rats receiving a combined insult of alcohol and burn injury compared with rats receiving either burn injury or alcohol alone. This is accompanied by a decrease in BF and DO2 to the liver and intestine. No significant change in BF to the coronary arteries (heart), brain, lung, skin, and muscles was observed after alcohol and burn injury. In conclusion, the results presented here suggest that alcohol ingestion before burn injury reduces splanchnic BF and DO2. Such decreases in BF and DO2 may cause hypoxic insult to the intestine and liver. Although a hypoxic insult to the liver would result in a release of proinflammatory mediators, a similar insult to the intestine will likely perturb both intestinal immune cell and barrier functions, as observed in our previous study.
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Affiliation(s)
- Mashkoor A Choudhry
- Center for Surgical Research and Department of Surgery, University of Alabama, Birmingham, Alabama 35294, USA.
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Crookes BA, Cohn SM, Bonet H, Burton EA, Nelson J, Majetschak M, Varon AJ, Linden JM, Proctor KG. Building a Better Fluid for Emergency Resuscitation of Traumatic Brain Injury. ACTA ACUST UNITED AC 2004; 57:547-54. [PMID: 15454801 DOI: 10.1097/01.ta.0000135162.85859.4c] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Hextend (HEX) is a colloid solution that is FDA-approved for volume expansion during surgery. ATL-146e is a novel adenosine A2A receptor agonist that has anti-inflammatory, neuroprotective, and coronary vasodilator properties. Three series of experiments were designed to evaluate the therapeutic potential of HEX+/-ATL-146e for emergency resuscitation from traumatic brain injury (TBI) + hemorrhagic hypotension. METHODS In the first two studies in vivo, anesthetized, ventilated pigs (30-45 kg) received a fluid percussion TBI, 45% arterial hemorrhage, and 30 minutes shock period. In Series 1, resuscitation consisted of unlimited crystalloid (n = 8) or HEX (n = 8) to correct systolic arterial pressure >100 mm Hg and heart rate <100 bpm for the first 60 minutes ("emergency phase"), and then maintain cerebral perfusion pressure (CPP) > 70 mm Hg for 60-240 minutes. In Series 2 (n = 31), resuscitation consisted of a 1 L bolus of HEX + ATL-146e (10 ng/kg/min, n = 10) or HEX +placebo (n = 10) followed by crystalloid to the same endpoints. In Series 3 in vivo, the hemodynamic response evoked by 0, 10, 50, or 100 ng/kg/min ATL-146e was measured before or 60 minutes after HEX resuscitation from 45% hemorrhage. RESULTS Following TBI+hemorrhage, there were 4/22 deaths in series 1 and 11/31 deaths in series 2. In those alive at 30 minutes, mean arterial pressure, cardiac index, mixed venous O2 saturation, and cerebral venous O2 saturation were all reduced by 40-60%, while heart rate and lactate were increased 2-5 fold. With no resuscitation (n = 2), there was minimal hemodynamic compensation and progressive acidosis. Upon resuscitation, these values corrected but intracranial pressure progressively rose from <5 mm Hg to 15-20 mm Hg. Series 1: With HEX (n = 8) versus crystalloid (n = 8), CPP was less labile, acid/base was maintained, and the fluid requirement was reduced by 60% (all p < 0.05) Series 2: With ATL-146e (n = 10) versus placebo (n = 10), stroke volume and cardiac output were improved by 40-60%, and the fluid requirement was reduced by 30% (all p < 0.05). Series 3: ATL-146e caused a dose-related increase (p < 0.05) in stroke volume after, but not before, hemorrhage. The effects on pre-load, afterload, and heart rate were similar before and after hemorrhage. CONCLUSIONS HEX alone is a safe and efficacious low volume alternative to initial crystalloid resuscitation after TBI. An adenosine A2A agonist combined with 1 L of HEX safely and effectively counteracted a decrease in cardiac performance noted after TBI+hemorrhage without causing hypotension or bradycardia.
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Affiliation(s)
- Bruce A Crookes
- Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami School of Medicine, Miami, Florida, USA
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