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ABSTRACT: OBJECTIVE: This study investigated the relationship between traumatic coagulopathy and severe brain swelling (SBS) during decompressive surgery to evacuate a supratentorial intradural mass lesion in patients with traumatic brain injury (TBI). METHODS: A retrospective study was conducted in 96 patients who consecutively suffered from isolated TBI and underwent decompressive surgery to evacuate a supratentorial traumatic mass lesion by unilateral craniotomy. Their medical history, radiographic information, and surgical notes were reviewed. The relationship between traumatic coagulopathy and intraoperative SBS was evaluated. RESULTS: Fifty-six patients presented with traumatic coagulopathy according to their preoperative coagulation panels. Thirty of them had the disorder corrected before surgery while the remaining patients did not. Twenty-four patients developed intraoperative SBS, and 22 (91.7%) of them were related to new or progressive formation of distal intracranial lesions during the surgery. Patients with uncorrected coagulopathy demonstrated a significantly higher risk of intraoperative SBS than those with corrected and no coagulopathy (61.5% vs 11.4%, P < 0.001). There was no significant difference in the incidence of intraoperative SBS between patients with corrected and no coagulopathy (13.3% versus 10.0%, PP > 0.05). Multivariate logistic regression analysis showed that uncorrected coagulopathy was an independent risk factor and related to an 11.5-fold increased risk of intraoperative SBS. CONCLUSIONS: Intraoperative SBS is not a rare event during decompressive surgery to evacuate a supratentorial intradural mass lesion in patients with TBI. Such surgery should be cautiously considered and performed given the existence of uncorrected traumatic coagulopathy, which is associated with an increased risk of intraoperative SBS.
Neurological Research 02/2013; · 1.52 Impact Factor
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ABSTRACT: OBJECTIVE: This study investigated the relationship among intracranial pressure (ICP), the development of acute lung injury (ALI) and systemic inflammatory response syndrome (SIRS) following a severe traumatic brain injury (TBI). METHODS: Post-traumatic ICP was continuously monitored for the first week following injury in a series of consecutive patients with isolated severe TBI. The initial ICP and the duration of intracranial hypertension (ICH) were calculated. The risk factors associated with the development of ALI and SIRS were evaluated. RESULTS: Of the 86 patients enrolled, 22 patients developed ALI and 52 patients developed SIRS during the observation period. The patients with ALI presented with a significantly higher initial ICP (31.3±7.8mmHg vs. 23.0±8.8mmHg, p<0.001) and a longer duration of ICH (16.8±6.5h vs. 11.9±6.0h, p=0.002) than those without ALI. The incidence of both ALI and SIRS increased with increasing initial ICP, and the presence of SIRS was associated with a fourfold increase in the risk of developing ALI (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.2-13.0). CONCLUSIONS: Increased ICP is associated with increased risks of developing ALI and SIRS following severe TBI. Future studies designed to verify the causative relationship between increased ICP and the systemic responses are warranted.
Clinical neurology and neurosurgery 09/2012; · 1.30 Impact Factor
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ABSTRACT: We investigated surgical outcomes of haematoma evacuation in patients with hypertensive putaminal haemorrhage, with emphasis on the development of postoperative refractory intracranial hypertension. Twenty-two consecutive patients with hypertensive putaminal haemorrhage underwent microsurgical clot removal without decompressive craniectomy. Medical histories, radiographic findings, and surgical notes were reviewed. Twenty patients survived to discharge. Twelve patients with preoperative transtentorial herniation, demonstrating a greater haematoma volume and lower Glasgow Coma Scale (GCS) score, had significantly elevated postoperative intracranial pressure. Five of these patients developed refractory intracranial hypertension (42%), and two of these patients died. Conversely, none of the 10 patients without preoperative transtentorial herniation experienced refractory intracranial hypertension, and they had a better outcome at discharge. The preoperative presence of clinical transtentorial herniation may predict the development of postoperative refractory intracranial hypertension, which may require decompressive craniectomy.
Journal of Clinical Neuroscience 05/2012; 19(7):975-9. · 1.25 Impact Factor
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ABSTRACT: To investigate the safety and efficacy of high positive end-expiratory pressure (PEEP) ventilation strategy for acute respiratory distress syndrome (ARDS) after traumatic brain injury.
A case report and discussion based on literature review.
This article reports the case of a 17-year-old male patient who developed ARDS after severe traumatic brain injury. PEEP was applied and adjusted to appropriate levels on the basis of information obtained from continuous monitoring of cerebral and systemic haemodynamics. Data from medical charts, surgical notes and radiographic findings were reviewed and analysed.
With the application of high PEEP ventilation, the patient survived ARDS following severe traumatic brain injury and achieved a favourable neurological outcome. A titration of PEEP levels from 5-15 cm H₂O in the patient resulted in acceptable changes of cerebral and systemic haemodynamics, including an increase of intracranial pressure (ICP) from 15 to 18 mmHg and a decrease of cerebral perfusion pressure (CPP) from 78 to 72 mmHg.
With close monitoring of cerebral and systemic haemodynamics, PEEP can be safely applied and titrated to an optimal level in the management of ARDS following traumatic brain injury.
Brain Injury 01/2012; 26(6):887-90. · 1.36 Impact Factor
