Critical care management of severe traumatic brain injury in adults

Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine (Impact Factor: 2.03). 02/2012; 20(1):12. DOI: 10.1186/1757-7241-20-12
Source: PubMed


Traumatic brain injury (TBI) is a major medical and socio-economic problem, and is the leading cause of death in children and young adults. The critical care management of severe TBI is largely derived from the "Guidelines for the Management of Severe Traumatic Brain Injury" that have been published by the Brain Trauma Foundation. The main objectives are prevention and treatment of intracranial hypertension and secondary brain insults, preservation of cerebral perfusion pressure (CPP), and optimization of cerebral oxygenation. In this review, the critical care management of severe TBI will be discussed with focus on monitoring, avoidance and minimization of secondary brain insults, and optimization of cerebral oxygenation and CPP.

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    • "They revealed a presence of widespread injury (diffuse axonal injury or diffuse oedema, n ¼3), focal frontal and/or temporal damage (n ¼6), or mixed brain damage (n ¼6). The patients showed a heterogeneity of severity and lesions as is usual in this population (Carlesimo et al., 1998; Haddad and Arabi, 2012; Knight and O'Hagan, 2009; Piolino et al., 2007; Saatman et al., 2008). Table 1 Demographic data and mean summary neuropsychological testing data for the TBI and control groups. "
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    ABSTRACT: We investigated for the first time the episodic/semantic distinction in remembering the past and imagining the future in traumatic brain injury (TBI), and explored cognitive mechanisms that may underlie their deficits. Fifteen severe TBI patients and 15 control participants performed a battery of neuropsychological tests and a set of verbal fluency tasks designed to assess semantic (personality traits knowledge and general events), and episodic (specific events and details) facets of self-representations according to three time periods (remote/retrograde past, recent/anterograde past, future). Compared to controls, TBI patients showed deficits in both semantic and episodic self-representations, regardless of the time period, and controlling for basic cognitive functions. By contrast, a subjective evaluation of self-concept measuring the degree of certitude and the valence of self did not differ between patients and controls. The deficits were mainly predicted by altered executive function (i.e., updating) for past periods, as well as by general semantic and feature binding in working memory for the future period, independently of the injury characteristics. For controls, only episodic self-representation for each time period was mediated by executive or working memory functions, while semantic self-representation was mediated by the certitude of the self. This study highlights the dual role of semantic and episodic representations in temporally extended self, and shows the global disruption of self-representations across extended time in severe TBI. This encourages the extension of past and future thinking research to TBI populations to provide important insights into the nature and origin of these deficits and their role in recovery and to suggest future lines of research on rehabilitation procedures. Copyright © 2015. Published by Elsevier Ltd.
    Neuropsychologia 05/2015; DOI:10.1016/j.neuropsychologia.2015.03.014 · 3.30 Impact Factor
    • "Acute respiratory distress syndrome (ARDS) is not an uncommon feature in patients with traumatic brain injury. The management plan for ARDS requires permissive hypercapnia, whereas, raised intracranial pressure (ICP) is managed by normocapnia or hypocapnia, which in a way are contradictory to each other.[1] "
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    ABSTRACT: Patients with traumatic brain injury complicated by acute respiratory distress syndrome (ARDS) are not uncommon in intensive care unit (ICU). The ventilatory management of patients combined with both of these catastrophic conditions is not straightforward. Evidence-based permissive hypercapnia strategy for ARDS could be fatal in patients with intracranial hypertension. Adjunctive use of inhaled nitric oxide (INO) is well-defined as a rescue therapy in severe ARDS, but its specific role in intracranial hypertension is somewhat uncertain. We report a case, which following traumatic brain injury developed both intracranial hypertension and ARDS. INO was given for ARDS, but coincidentally it also improved the raised intracranial pressure (ICP) and patient's neurological outcome. The case report will be followed by literature review on the role of INO in raised ICP.
    Indian Journal of Critical Care Medicine 06/2014; 18(6):392-5. DOI:10.4103/0972-5229.133931
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    • "During the early stages of hospital care, trauma patients may require management in a variety of settings including the emergency department, radiology department, and operating room; many of them are finally admitted to the Intensive Care Unit (ICU). Once the severely injured patient has been transferred to the ICU, his\her management consists of the provision of high-tech quality care and implementation of strategies to stabilize the patient, optimize the hemodynamic status and oxygenation, provide good hygiene and prevent local and systemic complications (2). These patients usually require prolonged bladder and bowel care, minimum environmental stimulation, suitable positioning, maintenance of patient safety and mechanical ventilation (3). "
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    ABSTRACT: Many patients with severe traumatic injuries are admitted to intensive care units (ICU). These patients usually require prolonged mechanical ventilation. These interventions require oral intubation and leave the mouth open which consequently impairs the natural antimicrobial activity in the mouth and airways. These patients are also prone to ventilator-associated pneumonia (VAP). Evidence shows that paying attention to oral hygiene in patients under mechanical ventilation is important in helping to prevent VAP.
    Trauma Monthly 04/2014; 19(2):e15110. DOI:10.5812/traumamon.15110
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