Indomethacin for controlling internal skull pressure in adults with severe traumatic brain injury

Review question

Indomethacin (also known as indometacin) is a drug that causes vasoconstriction, that is, it makes blood vessels narrower. We were interested in finding out how treating adults (18 years and over) with indomethacin, compared with not administering indomethacin, affects raised pressure inside the skull (cranium) that has been caused by a severe traumatic brain injury.

Background

Traumatic brain injury occurs when an external force injures the head. The trauma damages the brain in two different phases; firstly, at the time of impact, and then during the minutes and days following the injury, when the pressure within the skull rises (raised intracranial pressure). This is important because raised intracranial pressure is a common cause of death and disability in people with a brain injury. It is estimated that about 11% of people with traumatic brain injury die.

Indomethacin is a drug that some researchers think can reduce intracranial pressure, and so improve the recovery of people with traumatic brain injury.

Search date

We searched for randomised controlled studies, which provide the most reliable evidence, up to 23 August 2019.

Study characteristics

We found that no randomised studies, either completed or ongoing, had investigated our review question.

Key results

We found no trials, either completed or ongoing, that answered our review question. Thus, this review cannot draw any conclusions about the effects of indomethacin on raised intracranial pressure, mortality rates, quality of life, disability or adverse effects in adults.

Quality of the evidence

There is no evidence from randomised studies to guide healthcare professionals about the effects (benefits or harms) of using indomethacin to control the raised intracranial pressure that follows severe traumatic brain injury in adults. Therefore, it was not possible to assess the quality of the evidence.

Conclusions

We are uncertain about the effects of indomethacin in adults with severe traumatic brain injury. This absence of evidence should not be interpreted as evidence that indomethacin does not work, but means that we did not identify eligible research for this review, and that the effects of indomethacin have yet to be determined by appropriately designed clinical studies.

Authors' conclusions: 

We found no studies, either completed or ongoing, that assessed the effects of indomethacin in controlling intracranial hypertension secondary to severe traumatic brain injury. Thus, we cannot draw any conclusions about the effects of indomethacin on intracranial pressure, mortality rates, quality of life, disability or adverse effects.

This absence of evidence should not be interpreted as evidence of no effect for indomethacin in controlling intracranial hypertension secondary to severe traumatic brain injury. It means that we have not identified eligible research for this review.

Read the full abstract...
Background: 

Among people who have suffered a traumatic brain injury, increased intracranial pressure continues to be a major cause of early death; it is estimated that about 11 people per 100 with traumatic brain injury die.

Indomethacin (also known as indometacin) is a powerful cerebral vasoconstrictor that can reduce intracranial pressure and, ultimately, restore cerebral perfusion and oxygenation. Thus, indomethacin may improve the recovery of a person with traumatic brain injury.

Objectives: 

To assess the effects of indomethacin for adults with severe traumatic brain injury.

Search strategy: 

We ran the searches from inception to 23 August 2019. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 8) in the Cochrane Library, Ovid MEDLINE, Ovid Embase, CINAHL Plus (EBSCO), four other databases, and clinical trials registries. We also screened reference lists and conference abstracts, and contacted experts in the field.

Selection criteria: 

Our search criteria included randomised controlled trials (RCTs) that compared indomethacin with any control in adults presenting with severe traumatic brain injury associated with elevated intracranial pressure, with no previous decompressive surgery.

Data collection and analysis: 

Two review authors independently decided on the selection of the studies. We followed standard Cochrane methods.

Main results: 

We identified no eligible studies for this review, either completed or ongoing.

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