Elevated intracranial pressure after head trauma can be suppressed by antisecretory factor\u2014a pilot study

Kliment Gatzinsky,Stefan Lange,Eva Jennische,Merna Oshalim,Ewa Johansson

doi:10.1007/s00701-020-04407-5

Kliment Gatzinsky, Stefan Lange + Show 3 more

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https://doi.org/10.1007/s00701-020-04407-5

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Abstract

BackgroundControl of intracranial pressure (ICP) is a key element in neurointensive care for directing treatment decisions in patients with severe traumatic brain injury (TBI). The anti-inflammatory protein antisecretory factor (AF) has been demonstrated to reduce experimentally induced high ICP in animal models. This report describes the first steps to investigate the uptake, safety, and influence of AF for reduction of elevated ICP in patients with TBI in a clinical setting.MethodFour patients with severe TBI (Glasgow Coma Scale < 9) that required neurointensive care with ICP monitoring due to signs of refractory intracranial hypertension were investigated. One hundred milliliters of Salovum®, a commercially available egg yolk powder with high contents of AF peptides, was administrated either via nasogastric (patients 1 and 2) or rectal tube (patients 2, 3, and 4) every 8 h for 2 to 3 days as a supplement to the conventional neurointensive care. ICP was registered continuously. Plasma levels of AF were measured by enzyme-linked immunosorbent assay (ELISA) to confirm that Salovum® was absorbed appropriately into the bloodstream.ResultsIn the first two patients, we observed that when delivered by the nasogastric route, there was an accumulation of the Salovum® solution in the stomach with difficulties to control ICP due to impaired gastric emptying. Therefore, we tested to administer Salovum® rectally. In the third and fourth patients, who both showed radiological signs of extensive brain edema, ICP could be controlled during the course of rectal administration of Salovum®. The ICP reduction was statistically significant and was accompanied by an increase in blood levels of AF. No adverse events that could be attributed to AF treatment or the rectal approach for Salovum® administration were observed.ConclusionsThe outcomes suggest that AF can act as a suppressor of high ICP induced by traumatic brain edema. Use of AF may offer a new therapeutic option for targeting cerebral edema in clinical practice.

Highlights

One of the common causes of the bad outcome in patients exposed to severe closed head trauma is the development of cerebral edema with brain swelling and intracranialThis article is part of the Topical Collection on Brain traumaDepartment of Neurosurgery, Sahlgrenska University Hospital, SE-413 45 Gothenburg, SwedenDepartment of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, SwedenRegion Västra Götaland, Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden hypertension which can cause herniation, leading to irreversible brain injury and death [15, 26]
The initial computed tomography (CT) scan showed a thin acute subdural hematoma over the right cerebral hemisphere and bifrontal contusions which were most prominent on the right side
Due to gastroparesis, there was a gradual increase in gastric fluid volume after administration of Salovum® which was documented by aspiration via the nasogastric tube

Summary

Introduction

One of the common causes of the bad outcome in patients exposed to severe closed head trauma is the development of cerebral edema with brain swelling and intracranial. Reducing intracranial pressure (ICP) in a timely manner is a critical step in neurointensive care and forms the premise for appropriate secondary damage control and successful clinical outcome and rehabilitation of these patients. Control of intracranial pressure (ICP) is a key element in neurointensive care for directing treatment decisions in patients with severe traumatic brain injury (TBI). This report describes the first steps to investigate the uptake, safety, and influence of AF for reduction of elevated ICP in patients with TBI in a clinical setting. Method Four patients with severe TBI (Glasgow Coma Scale < 9) that required neurointensive care with ICP monitoring due to signs of refractory intracranial hypertension were investigated. Plasma levels of AF were measured by enzyme-linked immunosorbent assay (ELISA) to confirm that Salovum® was absorbed appropriately into the bloodstream

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