Critical Care and Shock

The effect of selective COX-2 inhibitor on blood glutamate in moderate traumatic brain injury

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Head injury is the leading cause of death and disability in adolescence, children and the elderly. Post-traumatic brain damage is determined by combination of primary and secondary head injuries. Neuroinflammation is one mechanism of secondary brain injury. Selective cyclooxygenase (sCOX-2) inhibitors are drugs commonly used in treatment of postoperative pain but also possess an anti-inflammatory effect. The aim of this study is to determine the role of sCOX-2 inhibitors to inhibit the inflammatory processes in patients with head injury by measuring the glutamate levels.

This is a double blind randomized controlled study involving patients with moderate head injuries who underwent surgery at Dr. Hasan Sadikin Hospital Bandung since December 2013 until December 2015. After obtaining study approval from the Research Ethics Committees of School of Medicine Padjadjaran University/Dr. Hasan Sadikin Hospital, samples were clustered randomly into 5 groups: the control group, the COX2-group I (given sCOX-2 inhibitor once/day), the COX2-group II (given sCOX-2 inhibitor twice/day), the COX2-group III (given sCOX-2 inhibitor thrice/day), and the COX2-group IV (given sCOX-2 inhibitor four times/day), and each group consisted of 6 patients. All patients received standard therapy as recommended by Brain Trauma Foundation Guidelines 2007 as well as performed monitoring of blood pressure, pulse rate, respiratory rate, oxygen saturation, temperature and blood sugar during pre and postoperative stages. The data were analyzed using paired samples t-test and one-way Anova, which p<0.05 is considered as statistically significant.

Results showed that there was a significant reduction in glutamate level in COX2-group II with the p-value of 0.035. The study concluded that sCOX-2 inhibitor has a brain protective effect by lowering the levels of glutamate as neuroinflammatory biomarkers in patients with head injury.