pituitrin and Brain-Damage--Chronic

The use of vasopressin in patients with cardiac arrest presenting with specific rhythms is controversial. We performed an evidence-based emergency medicine review of evidence comparing vasopressin to epinephrine in structured cardiac arrest protocols.. We searched MEDLINE, EMBASE, the Cochrane Library, and other databases for randomized trials or systematic reviews comparing vasopressin to epinephrine for adults with cardiac arrest and measuring survival to hospital discharge and neurologic function in survivors. We used standard criteria to appraise the quality of published trials and systematic reviews. We used the random effects model in supplementary analyses to summarize results and to test for significant differences across subgroups of patients presenting with different arrest rhythms.. We found 3 high-quality well-reported randomized trials and 1 rigorous meta-analysis. The evidence does not confirm a consistent benefit of vasopressin over epinephrine in increasing survival or improving neurologic outcome in survivors. Subgroup analysis reveals a large difference in effect of vasopressin over epinephrine in cardiac arrest patients with asystole, compared to other arrest rhythms, coming from within-trial comparisons. The difference is not consistent across otherwise similar trials, is not statistically significant, may reflect the application of multiple unplanned subgroup analyses, and is not supported by a plausible biological hypothesis.. Evidence from randomized trials does not establish a benefit of vasopressin over epinephrine in increasing survival to discharge or improving neurologic outcomes in adult patients with nontraumatic cardiac arrest.

Topics: Brain Damage, Chronic; Emergency Medical Services; Epinephrine; Evidence-Based Medicine; Heart Arrest; Humans; Odds Ratio; Patient Discharge; Randomized Controlled Trials as Topic; Research Design; Resuscitation; Survival Analysis; Vasoconstrictor Agents; Vasopressins

Topics: Amphetamine; Angiotensin II; Barbiturates; Brain Damage, Chronic; Cardiac Glycosides; Computers; Dehydration; Diuretics; Drinking; Drinking Behavior; Eating; Electric Stimulation; Electrolytes; Endocrine Glands; Hot Temperature; Humans; Hypothyroidism; Insulin; Kidney; Parasympatholytics; Parasympathomimetics; Renin; Serotonin; Thirst; Time Factors; Vasopressins

We describe two children who after cardiopulmonary arrest developed hypernatremia at the terminal stage. Urinary antidiuretic hormone concentration was very low, indicating central diabetes insipidus. These cases illustrate the necessity of alertness to the development of central diabetes insipidus in patients with severe hypoxic brain damage.

Topics: Adolescent; Airway Obstruction; Brain Damage, Chronic; Cerebral Palsy; Diabetes Insipidus; Humans; Hypoxia, Brain; Infant; Male; Pituitary Gland, Posterior; Resuscitation; Vasopressins; Water-Electrolyte Balance

Nineteen children aged four months to 15 years with diabetes insipidus (DI) secondary to severe brain insults were studied. The main primary brain insult was severe head injury in 12, anoxic ischemic brain damage in four, encephalitis in two, Reye's syndrome in one. Sixteen children died, and three survived. The time from insult to onset of polyuria varied from several hours to one month, and was significantly shorter in head trauma patients, 1.8 +/- 0.9 vs. 9.3 +/- 1.9 days for patients with anoxic ischemic brain damage (p less than 0.03). Twelve of the 19 patients met the criteria for brain death at onset of DI. Treatment by appropriate fluids and vasopressin resulted in resolution of polyuria and increase in urine osmolality. Ten patients developed DI while being treated with dopamine for hemodynamic support. In two of these patients, the cessation of dopamine was time-related to the resolution of DI. Our results indicate that as many as 15% of children with DI (with 95% confidence) following severe brain injury may survive. Hence, despite the overall poor prognosis, its occurrence does not necessarily indicate brain death.

Topics: Adolescent; Brain Damage, Chronic; Brain Death; Brain Injuries; Child; Child, Preschool; Combined Modality Therapy; Diabetes Insipidus; Dopamine; Female; Fluid Therapy; Humans; Infant; Male; Prognosis; Vasopressins

Topics: Aged; Brain Damage, Chronic; Bronchial Neoplasms; Humans; Hypothyroidism; Male; Vasopressins; Water-Electrolyte Balance

Topics: Angiotensins; Aortic Diseases; Brain; Brain Damage, Chronic; Dehydration; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Hexamethonium Compounds; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Kidney Function Tests; Norepinephrine; Physiology; Renal Artery Obstruction; Vasopressins; Water-Electrolyte Balance