OBJECTIVES: To describe acute cerebral hemodynamic effects of medications commonly used to treat @entity428 in @entity1 with @entity131 . Currently, data supporting the efficacy of these medications are insufficient. DESIGN: In this prospective observational study, @entity428 (intracranial pressure >=  20 mm Hg for > 5 min) was treated by clinical protocol. Administration times of medications for @entity428 ( @entity3575 , 3% hypertonic saline, @entity2656 , and @entity4485 ) were prospectively recorded and synchronized with an automated database that collected intracranial pressure and cerebral perfusion pressure every 5 seconds. Intracranial pressure crises confounded by external stimulation or mechanical ventilator adjustments were excluded. Mean intracranial pressure and cerebral perfusion pressure from epochs following drug administration were compared with baseline values using Kruskal-Wallis analysis of variance and Dunn test. Frailty modeling was used to analyze the time to intracranial pressure crisis resolution. Mixed-effect models compared intracranial pressure and cerebral perfusion pressure 5 minutes after the medication versus baseline and rates of treatment failure. SETTING: A tertiary care @entity1 's hospital. @entity1 : @entity1 with severe @entity131 (Glasgow @entity772 Scale score  <= 8). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed 196 doses of @entity3575 , hypertonic saline, @entity2656 , and @entity4485 administered to 16 @entity1 (median: 12 doses per @entity1 ). Overall, intracranial pressure significantly decreased following the administration of @entity3575 , hypertonic saline, and @entity4485 . After controlling for administration of multiple medications, intracranial pressure was decreased following hypertonic saline and @entity4485 administration; cerebral perfusion pressure was decreased following @entity3575 and was increased following hypertonic saline administration. After adjusting for significant covariates (including age, Glasgow @entity772 Scale score, and intracranial pressure), hypertonic saline was associated with a two-fold faster resolution of @entity428 than either @entity3575 or @entity4485 . @entity3575 was significantly associated with the most frequent treatment failure. CONCLUSIONS: Intracranial pressure decreased after multiple drug administrations, but hypertonic saline may warrant consideration as the first-line drug for treating @entity428 , as it was associated with the most favorable cerebral hemodynamics and fastest resolution of @entity428 .

Effectiveness of Pharmacological Therapies for Intracranial Hypertension in XXXX With Severe @entity131 Injury-Results From an Automated Data Collection System Time-Synched to Drug Administration.

@entity1 :: ('9606', 'Species') :: ['children', 'PATIENTS', 'Children', 'patient'] @entity2656 :: ('MESH:D008353', 'Chemical') :: ['mannitol'] @entity131 :: ('MESH:D001930', 'Disease') :: ['traumatic brain injury'] @entity4485 :: ('MESH:D010424', 'Chemical') :: ['pentobarbital'] @entity428 :: ('MESH:D019586', 'Disease') :: ['intracranial hypertension'] @entity772 :: ('MESH:D003128', 'Disease') :: ['Coma'] @entity3575 :: ('MESH:D005283', 'Chemical') :: ['fentanyl', 'Fentanyl']
@entity1 :: (9606,Species) :: ['Children']
