Prostacyclin in trauma patients with hemorrhagic shock-A Randomized Clinical Trial

Pär I Johansson, Christian Fenger Eriksen, Pernille E Bovbjerg, Christine Gaarder, Marlene Pall, Hanne Hee Henriksen, Kristine H Pedersen, Martin Vigstedt, Theis Lange, Pål Aksel Næss, Mikkel Strømgaard Andersen, Hans Kirkegaard, Jakob Stensballe

Abstract

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.

OriginalsprogEngelsk
TidsskriftThe journal of trauma and acute care surgery
Vol/bind96
Udgave nummer3
Sider (fra-til)476-481
Antal sider6
ISSN2163-0755
DOI
StatusUdgivet - 1 mar. 2024

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