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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Available from: Yaseen Arabi, Oct 09, 2015
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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
    • "For the treatment of hypertension an infusion of a short acting beta blocker, like esmolol, is very useful. These agents do not cause cerebral vasodilatation, when compared with nitrates and calcium channel blockers and therefore do not increase cerebral blood volume and ICP.[30] "
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    ABSTRACT: Background: Traumatic brain injury (TBI) is a growing epidemic throughout the world and may present as major global burden in 2020. Some intensive care units throughout the world still have no access to specialized monitoring methods, equipments and other technologies related to intensive care management of these patients; therefore, this review is meant for providing generalized supportive measurement to this subgroup of patients so that evidence based management could minimize or prevent the secondary brain injury. Methods: Therefore, we have included the PubMed search for the relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic. Results: General supportive measures are equally important to prevent and minimize the effects of secondary brain injury and therefore, have a substantial impact on the outcome in patients with TBI. The important considerations for general supportive intensive care unit care remain the prompt reorganization and treatment of hypoxemia, hypotension and hypercarbia. Evidences are found to be either against or weak regarding the use of routine hyperventilation therapy, tight control blood sugar regime, use of colloids and late as well as parenteral nutrition therapy in patients with severe TBI. Conclusion: There is also a need to develop some evidence based protocols for the health-care sectors, in which there is still lack of specific management related to monitoring methods, equipments and other technical resources. Optimization of physiological parameters, understanding of basic neurocritical care knowledge as well as incorporation of newer guidelines would certainly improve the outcome of the TBI patients.
    04/2014; 8(2):256-63. DOI:10.4103/1658-354X.130742
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