Traumatic brain injury: intensive care management
TLDR
This review will discuss the intensive care management of severe TBI with emphasis on the specific measures directed at the control of intracranial pressure and CPP.Abstract:
Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. The modern management of severe TBI has fallen into the domain of a multidisciplinary team led by neurointensivists, neuroanaesthetists, and neurosurgeons and is based on the avoidance of secondary injury, maintenance of cerebral perfusion pressure (CPP), and optimization of cerebral oxygenation. In this review, we will discuss the intensive care management of severe TBI with emphasis on the specific measures directed at the control of intracranial pressure and CPP.read more
Citations
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Journal ArticleDOI
Critical thresholds for cerebrovascular reactivity after traumatic brain injury.
Enrico Sorrentino,Jennifer Diedler,Magdalena Kasprowicz,Karol P. Budohoski,Christina Haubrich,Peter Smielewski,Joanne G. Outtrim,Anne E. Manktelow,Peter J. Hutchinson,John D. Pickard,David K. Menon,Marek Czosnyka +11 more
TL;DR: The prognostic role of PRx is confirmed but with a lower threshold of 0.05 for favorable outcome than for survival (0.25) and the lower value in elderly and in females suggests increased vulnerability to intracranial hypertension in these groups.
Journal ArticleDOI
The cytokine response to human traumatic brain injury: temporal profiles and evidence for cerebral parenchymal production.
TL;DR: Evidence is provided for the cerebral production of these cytokines after severe TBI and they show a stereotyped temporal pattern after TBI.
Journal ArticleDOI
Traumatic brain injury: assessment, resuscitation and early management
TL;DR: There is very little evidence positively in favour of any treatments or packages of early care for head-injured patients; however, prompt, specialist neurocritical care is associated with improved outcome.
Journal ArticleDOI
Transcranial Doppler Pulsatility Index: What it is and What it Isn’t
Nicolás de Riva,Nicolás de Riva,Karol P. Budohoski,Peter Smielewski,Magdalena Kasprowicz,Magdalena Kasprowicz,Christian Zweifel,Christian Zweifel,Luzius A. Steiner,Luzius A. Steiner,Matthias Reinhard,Matthias Reinhard,Neus Fàbregas,John D. Pickard,Marek Czosnyka,Marek Czosnyka +15 more
TL;DR: TCD pulsatility index can be easily and quickly assessed but is usually misinterpreted as a descriptor of CVR, which presents a complex relationship between PI and multiple haemodynamic variables.
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Suppression of acute proinflammatory cytokine and chemokine upregulation by post-injury administration of a novel small molecule improves long-term neurologic outcome in a mouse model of traumatic brain injury
Eric Lloyd,Kathleen C. Somera-Molina,Kathleen C. Somera-Molina,Linda J. Van Eldik,D. Martin Watterson,Mark S. Wainwright,Mark S. Wainwright +6 more
TL;DR: The improvement in long-term functional neurologic outcome following suppression of cytokine upregulation in a clinically relevant therapeutic window indicates that selective targeting of neuroinflammation may lead to novel therapies for the major neurologic morbidities resulting from head injury, and indicates the potential of Mzc as a future therapeutic for TBI.
References
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Journal ArticleDOI
ASSESSMENT OF COMA AND IMPAIRED CONSCIOUSNESS: A Practical Scale
Graham M. Teasdale,Bryan Jennett +1 more
TL;DR: A clinical scale has been evolved for assessing the depth and duration of impaired consciousness and coma that facilitates consultations between general and special units in cases of recent brain damage, and is useful also in defining the duration of prolonged coma.
Journal ArticleDOI
Intensive Insulin Therapy in Critically Ill Patients
Greet Van den Berghe,Pieter Wouters,Frank Weekers,Charles Verwaest,Frans Bruyninckx,Miet Schetz,Dirk Vlasselaers,Patrick Ferdinande,Peter Lauwers,Roger Bouillon +9 more
TL;DR: Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.
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
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
TL;DR: 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.
Journal ArticleDOI
Lack of effect of induction of hypothermia after acute brain injury.
Guy L. Clifton,Emmy R. Miller,Sung C. Choi,Harvey S. Levin,Stephen R. McCauley,Kenneth R. Smith,Jan Paul Muizelaar,Franklin C. Wagner,Donald W. Marion,Thomas G. Luerssen,Randall M. Chesnut,Michael L. Schwartz +11 more
TL;DR: Treatment with hypothermia, with the body temperature reaching 33 degrees C within eight hours after injury, is not effective in improving outcomes in patients with severe brain injury.
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