Journal ArticleDOI
The role of secondary brain injury in determining outcome from severe head injury.
Randall M. Chesnut,Lawrence F. Marshall,Melville R. Klauber,Barbara A. Blunt,Nevan Baldwin,Howard M. Eisenberg,John A. Jane,Anthony Marmarou,Mary A. Foulkes +8 more
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TLDR
The increased morbidity and mortality related to severe trauma to an extracranial organ system appeared primarily attributable to associated hypotension, and improvements in trauma care delivery over the past decade have not markedly altered the adverse influence of hypotension.Abstract:
As triage and resuscitation protocols evolve, it is critical to determine the major extracranial variables influencing outcome in the setting of severe head injury. We prospectively studied the outcome from severe head injury (GCS score < or = 8) in 717 cases in the Traumatic Coma Data Bank. We investigated the impact on outcome of hypotension (SBP < 90 mm Hg) and hypoxia (Pao2 < or = 60 mm Hg or apnea or cyanosis in the field) as secondary brain insults, occurring from injury through resuscitation. Hypoxia and hypotension were independently associated with significant increases in morbidity and mortality from severe head injury. Hypotension was profoundly detrimental, occurring in 34.6% of these patients and associated with a 150% increase in mortality. The increased morbidity and mortality related to severe trauma to an extracranial organ system appeared primarily attributable to associated hypotension. Improvements in trauma care delivery over the past decade have not markedly altered the adverse influence of hypotension. Hypoxia and hypotension are common and detrimental secondary brain insults. Hypotension, particularly, is a major determinant of outcome from severe head injury. Resuscitation protocols for brain injured patients should assiduously avoid hypovolemic shock on an absolute basis.read more
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Journal ArticleDOI
Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition
Nancy Carney,Annette M Totten,Cindy O’Reilly,Jamie S. Ullman,Gregory W.J. Hawryluk,Michael J. Bell,Susan L. Bratton,Randall M. Chesnut,Odette A. Harris,Niranjan Kissoon,Andres M. Rubiano,Lori Shutter,Robert C. Tasker,Monica S. Vavilala,Jack Wilberger,David W. Wright,Jamshid Ghajar +16 more
TL;DR: The scope and purpose of this work is to synthesize the available evidence and to translate it into recommendations, so that these recommendations be used by others to develop treatment protocols, which necessarily need to incorporate consensus and clinical judgment in areas where current evidence is lacking or insufficient.
Journal ArticleDOI
Traumatic brain injury.
TL;DR: Quantification of cerebral perfusion by monitoring of intracranial pressure and treatment of cerebral hypoperfusion decrease secondary injury and an organised trauma system that allows rapid resuscitation and transport directly to an experienced trauma centre significantly lowers mortality and morbidity.
Journal ArticleDOI
Guidelines for the management of severe traumatic brain injury. Editor's Commentary.
Journal ArticleDOI
Decompressive Craniectomy in Diffuse Traumatic Brain Injury
D. James Cooper,Jeffrey V. Rosenfeld,Lynnette Murray,Yaseen M. Arabi,Andrew Davies,Thomas Kossmann,Jennie Ponsford,Ian Seppelt,Peter L. Reilly,Rory Wolfe +9 more
TL;DR: In adults with severe diffuse traumatic brain injury and refractory intracranial hypertension, early bifrontotemporoparietal decompressive craniectomy decreased intrac Cranial pressure and the length of stay in the ICU but was associated with more unfavorable outcomes.
Journal ArticleDOI
Cerebral perfusion pressure: management protocol and clinical results
TL;DR: These results are significantly better than other reported series across GCS categories in comparisons of death rates, survival versus dead or vegetative, or favorable versus nonfavorable outcome classifications.
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