Use of indomethacin in brain-injured patients with cerebral perfusion pressure impairment: preliminary report

✓ The effect of indomethacin, a cyclooxygenase inhibitor, was studied in the treatment of 10 patients with head injury and one patient with spontaneous subarachnoid hemorrhage, each of whom presented with high intracranial pressure (ICP) (34.4 ± 13.1 mm Hg) and cerebral perfusion pressure (CPP) impairment (67.0 ± 15.4 mm Hg), which did not improve with standard therapy using mannitol, hyperventilation, and barbiturates. The patients had Glasgow Coma Scale scores of 8 or less. Recordings were made of the patients' ICP and mean arterial blood pressure from the nurse's end-hour recording at the bedside, as well as of their CPP, rectal temperature, and standard therapy regimens. The authors assessed the effects of an indomethacin bolus (50 mg in 20 minutes) on ICP and CPP; an indomethacin infusion (21.5 ± 11 mg/hour over 30 ± 9 hours) on ICP, CPP, rectal temperature, and standard therapy regimens (matching the values before and during infusion in a similar time interval); and discontinuation of indomethacin t...