Professor Carle Health. Department of Critical Care.
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Introduction: Traumatic brain injury (TBI) is defined as an injury to the brain by an external force. They can present with paroxysmal sympathetic hyperactivity (PSH), a clinical disorder secondary to TBI which includes episodes of hypertension, tachycardia, tachypnea, fever, and dystonic postures. Standard treatment of TBI includes symptom management as well as strategies to reduce the chance of secondary injury due to hypoxia, cerebral hypoperfusion, or metabolic stress. Propranolol, a non-selective beta-blocker, is not part of the standard of care but has been hypothesized to aid in TBI management by quelling PSH; however, it is highly debated. Here, we conduct a scoping review to examine early propranolol administration in patients with TBI and its effects on patient outcomes.
Methods: We conducted a scoping review, following PRISMA guidelines, searching the PubMed and SCOPUS databases from 2015-2025 which included primary research articles and reviews on propranolol use in TBI. Eligible studies included randomized controlled trials, observational studies, and meta-analyses reporting on functional outcomes, mortality, or length of stay in the hospital and intensive care unit (ICU).
Results: Search of the PubMed database yielded twenty-two papers published in the recent decade on the topic of early propranolol administration in the treatment of traumatic brain injury. Reports showed conflicting conclusions on propranolol administration lowering mortality, and hospital and ICU length of stay. It is important to note that these studies are largely retrospective, often lack a considerable sample size and are not well controlled. A small body of prospective studies show a slight increase in the quality of life for those who were given propranolol as well as decreased length of stays and mortality. The prospective literature is far better controlled and often has greater sample sizes.
Conclusions: There is a critical gap in the acute care for patients with traumatic brain injury. A small body of evidence suggests that early propranolol administration significantly benefits TBI patients and reduces their burden on the healthcare system. Future research will determine the proper utilization of propranolol and its implications across age, sex, and other relevant risk factors.
