الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Injuries are a leading cause of death, disability, years of productive lives lost, and health care costs.The 2nd leading causes of death after injury are hemorrhagic shock and traumatic brain injury (TBI), in both military and civilian settings, with mortality rates of 30% to 50%.
Injured patients treated at designated trauma centers are more likely to survive than those treated at hospitals that are not trauma centers;however, risk-adjusted mortality rates are nearly 50% higherat some trauma centers than at others.Given that designatedtrauma centers have similar structures and resources, these variationsin risk-adjusted patient outcomes are likely explained byvariations in clinical practices.
The balance between benefits and harms of vasopressor therapy during the early phase of resuscitation following traumatic injury is uncertain.
In spite of the potential role of vasopressors as fluid-sparing adjuncts, vasopressors potentiate vasoconstriction and may therefore worsen peripheral and organ perfusion despite high blood pressure values. Nascent hemostatic clots may also be dislodged if normotension is rapidly achieved in a bleeding patient. Other interventions that increase blood pressure with limited fluid volumes, such as hypertonic saline, have been found to be harmful or to provide no important benefit in low risk of bias randomized controlled trials (RCTs).
The aim of this study was to investigate the effect of using early vasopressors on the outcomes in polytrauma patients with severe Traumatic Brain Injury (TBI) in the Emergency Department (ED).
In this experimental study, 100 adult polytrauma patients with severe TBI were enrolled. The percentage of males (72%) was higher than females (28%).Then, they were classified according to the use of vasopressor (Norepinephrine) during the 1st six hours. 50 patients received early vasopressor by the attending ED physician were mentioned as “early vasopressor group”. Another 50 patients received late after 6hrs from admission were mentioned as “non-early vasopressor group”.
In this study, early group showed better clinical improvement after 24 hours from admission measured as hemodynamics and GCS (p<0.001) .with a statistically significant between them.
Regarding mortality, the overall mortality rate was no a statistically significant difference between the 2 studied groups in their mortality rates (p= 0.317)
from the results of this study, in a mixed population of adult polytrauma patients with severe traumatic brain injury (TBI) and systolic blood pressure (SBP) ≤90 mmHg, using early vasopressor (within 6 hours from admission) during the resuscitation in the emergency department (ED) was associated with better clinical improvement measured as hemodynamics and Glasgow coma scale (GCS) after 24 hours, but without different in short term mortality within 24hrs.
We recommended, further larger multicentric studied should be conducted. The use of resuscitation fluids, FFP and PRBCs should be considered. Different types and doses of vasopressors should be considered. Long term outcomes as quality of life, cognitive function ormortality should be considered.