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management of acute severe traumatic brain injury

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https://www.readbyqxmd.com/read/28890524/diagnosis-and-management-of-patients-with-paroxysmal-sympathetic-hyperactivity-following-acute-brain-injuries-using-a-consensus-based-diagnostic-tool-a-single-institutional-case-series
#1
Shigeo Godo, Shigemi Irino, Atsuhiro Nakagawa, Yu Kawazoe, Motoo Fujita, Daisuke Kudo, Ryosuke Nomura, Hiroaki Shimokawa, Shigeki Kushimoto
Paroxysmal sympathetic hyperactivity (PSH) is a distinct syndrome of episodic sympathetic hyperactivities following severe acquired brain injury, characterized by paroxysmal transient fever, tachycardia, hypertension, tachypnea, excessive diaphoresis and specific posturing. PSH remains to be an under-recognized condition with a diagnostic pitfall especially in the intensive care unit (ICU) settings due to the high prevalence of concomitant diseases that mimic PSH. A consensus set of diagnostic criteria named PSH-Assessment Measure (PSH-AM) has been developed recently, which is consisted of two components: a diagnosis likelihood tool derived from clinical characteristics of PSH, and a clinical feature scale assigned to the severity of each sympathetic hyperactivity...
2017: Tohoku Journal of Experimental Medicine
https://www.readbyqxmd.com/read/28806209/refractory-intracranial-hypertension-the-role-of-decompressive-craniectomy
#2
Martin Smith
Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure...
August 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28802751/acute-management-of-hemostasis-in-patients-with-neurological-injury
#3
REVIEW
M Irem Baharoglu, Anneke Brand, Maria M Koopman, Marinus Vermeulen, Yvo B W E M Roos
Neurological injuries can be divided into those with traumatic and nontraumatic causes. The largest groups are traumatic brain injury (TBI) and nontraumatic stroke. TBI patients may present with intracranial hemorrhages (contusions, or subdural or epidural hematomas). Strokes are ischemic or hemorrhagic. In all these disorders, thrombosis and hemostasis play a major role. Treatment aims to either cease bleeding and/or restore perfusion. We reviewed hemostatic and thrombolytic therapies in patients with neurological injuries by MEDLINE and EMBASE search using various key words for neurological disorders and hemostatic therapies restricted to English language and human adults...
July 13, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/28795057/side-effects-of-indomethacin-in-refractory-post-traumatic-intracranial-hypertension-a-comprehensive-case-study-and-review
#4
REVIEW
Daniel Agustín Godoy, Pablo David Guerrero Suarez, Luis Rafael Moscote-Salazar, Mario Di Napoli
Intracranial hypertension (IH) is one of the final pathways of acute brain injury. In severe traumatic brain injury (sTBI), it independently predicts poor outcomes. Its control represents a key aspect of the management. Lack of response to conventional therapies signals a state of ''refractory IH'', with an associated mortality rate of 80-100%. In such cases, hypothermia, barbiturates at high doses (BBT), decompressive craniectomy (DC), and extreme hyperventilation are utilized. However, none of them has proven efficacy...
July 2017: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/28756471/the-research-agenda-for-trauma-critical-care
#5
REVIEW
Karim Asehnoune, Zsolt Balogh, Giuseppe Citerio, Andre Cap, Timothy Billiar, Nino Stocchetti, Mitchell J Cohen, Paolo Pelosi, Nicola Curry, Christine Gaarder, Russell Gruen, John Holcomb, Beverley J Hunt, Nicole P Juffermans, Mark Maegele, Mark Midwinter, Frederick A Moore, Michael O'Dwyer, Jean-François Pittet, Herbert Schöchl, Martin Schreiber, Philip C Spinella, Simon Stanworth, Robert Winfield, Karim Brohi
In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an individualised precision approach is superior to current empirical practice...
July 29, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28721596/central-adrenal-insufficiency-following-traumatic-brain-injury-a-missed-diagnosis-in-the-critically-injured
#6
Eileen Fan, Peter W Skippen, Michael A Sargent, David D Cochrane, Jean-Pierre Chanoine
BACKGROUND: High-dose steroid administration is no longer recommended in the treatment of acute traumatic brain injury (TBI) as it failed to prove beneficial in improving patients' outcome. However, a masked benefit of steroid administration in TBI management was that it provided corticosteroid replacement therapy in patients with TBI-related central adrenal insufficiency. CASE PRESENTATION: We report the case of a 12-year-old boy who suffered a severe TBI from a motor vehicle accident that resulted in complete deficiency of anterior pituitary function...
July 18, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28601130/neurobehavioral-management-of-traumatic-brain-injury-in-the-critical-care-setting-an-update
#7
REVIEW
Earl De Guzman, Andrea Ament
Traumatic brain injury (TBI) is an alteration in brain function, or other evidence of brain pathology, caused by an external force. TBI is a major cause of disability and mortality worldwide. Post-traumatic amnesia, or the interval from injury until the patient is oriented and able to form and later recall new memories, is an important index of TBI severity and functional outcome. This article will discuss the updates in the epidemiology, definition and classification, pathophysiology, diagnosis, and management of common acute neuropsychiatric sequelae of traumatic brain injury that the critical care specialist may encounter...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28585880/service-needs-and-barriers-to-care-five-or-more-years-after-moderate-to-severe-tbi-among-veterans
#8
R Jay Schulz-Heik, John H Poole, Marie N Dahdah, Campbell Sullivan, Maheen M Adamson, Elaine S Date, Rose Salerno, Karen Schwab, Odette Harris
PRIMARY OBJECTIVE: The objective of this paper is to identify the most frequent service needs, factors associated with needs, and barriers to care among Veterans and service members five or more years after moderate to severe traumatic brain injury (TBI). RESEARCH DESIGN: Survey administered via telephone 5-16 years after injury (median eight years) and subsequent acute inpatient rehabilitation at a regional Veterans Affairs (VA) medical centre. METHODS AND PROCEDURES: Participants were 119 Veterans and military personnel, aged 23-70 (median 35), 90% male...
June 6, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28538329/perioperative-care-for-pediatric-patients-with-penetrating-brain-injury-a-review
#9
Marco Mikhael, Elizabeth Frost, Maria Cristancho
Traumatic brain injury (TBI) continues to be the leading cause of death and acquired disability in young children and adolescents, due to blunt or penetrating trauma, the latter being less common but more lethal. Penetrating brain injury (PBI) has not been studied extensively, mainly reported as case reports or case series, due to the assumption that both types of brain injury have common pathophysiology and consequently common management. However, recommendations and guidelines for the management of PBI differ from those of blunt TBI in regards to neuroimaging, intracranial pressure (ICP) monitoring, and surgical management including those pertaining to vascular injury...
May 19, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28512614/postoperative-contralateral-hematoma-in-patient-with-acute-traumatic-brain-injury
#10
Myeong-Jin Oh, Je Hoon Jeong, Dong-Seong Shin, Sun-Chul Hwang, Soo Bin Im, Bum-Tae Kim, Won-Han Shin
OBJECTIVE: Head injury is a leading cause of death and disability in subjects who suffer a traumatic accident. Contralateral hematomas after surgery for traumatic brain injury are rare. However, an unrecognized, these hematomas can cause devastating results. We presented our experience of these patients and discussed diagnosis and management. METHODS: This study included 12 traumatic patients with acute traumatic brain injury who developed delayed contralateral hematoma after evacuation of an acute hematoma...
April 2017: Korean Journal of Neurotrauma
https://www.readbyqxmd.com/read/28467630/psychological-traits-predict-impaired-awareness-of-deficits-independently-of-neuropsychological-factors-in-chronic-traumatic-brain-injury
#11
Zorry Belchev, Neta Levy, Itamar Berman, Hila Levinzon, Dan Hoofien, Asaf Gilboa
OBJECTIVES: To dissociate injury-related factors from psychological contributions to impaired awareness of deficits following traumatic brain injury (TBI); impaired awareness is theorized to partly reflect psychological factors (e.g., denial), but empirical evidence for this theory is scarce. DESIGN: We examined how different factors predict awareness in patients undergoing rehabilitation (N = 43). Factors included (1) neurological (injury severity), (2) neuropsychological loss, (3) psychological (denial, projection, identification), and (4) personality (narcissism)...
May 3, 2017: British Journal of Clinical Psychology
https://www.readbyqxmd.com/read/28461273/posttraumatic-seizures-in-a-rural-nigerian-neurosurgical-service
#12
Taopheeq Bamidele Rabiu, Babatunde Adetunmbi
BACKGROUND: Traumatic brain injury (TBI) is a recognized risk factor for seizures. In Nigeria, there is paucity of literature on posttraumatic seizure (PTS). This study provides the profile and pattern of PTS in patients with TBI in a rural Nigerian neurosurgical service. METHODS: A prospective observational study of patients with TBI was performed. Clinical and radiological data including outcomes of care were analyzed with SPSS version 15. A P value of <0.05 was considered statistically significant...
August 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28460697/pediatric-mild-traumatic-brain-injury-and-population-health-an-introduction-for-nursing-care-providers
#13
REVIEW
Michelle Borzik Goreth
Despite increasing injury prevalence of traumatic brain injury (TBI) in children, most injuries in children are mild in severity. Even mild injuries can result in long-term or chronic effects not apparent until the child ages, resulting in increased economic burden and overall lifetime costs related to injury. Early recognition of TBI is essential for ongoing evaluation and management of acute symptoms and reduction of chronic health effects. Providing early interventions to manage acute and postconcussive symptoms and reducing health disparities in children with mild TBI can minimize adverse events that impact health-related quality of life for the injured child and their family and increase overall population health...
June 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28437224/structure-process-and-culture-of-intensive-care-units-treating-patients-with-severe-traumatic-brain-injury-survey-of-centers-participating-in-the-american-college-of-surgeons-trauma-quality-improvement-program
#14
Aziz S Alali, Victoria A McCredie, Todd G Mainprize, David Gomez, Avery B Nathens
Outcome after severe traumatic brain injury (TBI) differs substantially between hospitals. Explaining this variation begins with understanding the differences in structures and processes of care, particularly at intensive care units (ICUs) where acute TBI care takes place. We invited trauma medical directors (TMDs) from 187 centers participating in the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) to complete a survey. The survey domains included ICU model, type, availability of specialized units, staff, training programs, standard protocols and order sets, approach to withdrawal of life support, and perceived level of neurosurgeons' engagement in the ICU management of TBI...
May 17, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28435989/aggressive-medical-management-of-acute-traumatic-subdural-hematomas-before-emergency-craniotomy-in-patients-presenting-with-bilateral-unreactive-pupils-a-cohort-study
#15
Arturo Chieregato, Alessandra Venditto, Emanuele Russo, Costanza Martino, Giovanni Bini
BACKGROUND: The outcome of patients with severe traumatic brain injury (TBI) and acute traumatic subdural hematoma (aSDH) admitted to the emergency room with bilaterally dilated, unreactive pupils (bilateral mydriasis) is notoriously poor. METHODS: Of 2074 TBI patients consecutively admitted to our facility between 1997 and 2012, 115 had a first CT scan with aSDH, unreactive bilateral mydriasis, and a Glasgow Coma Score of 3 or 4. Sixty-two patients were unoperated and died within hours or a few days...
August 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28390522/research-frontiers-in-traumatic-brain-injury-defining-the-injury
#16
REVIEW
Andrew J Gardner, Shirley L Shih, Elizabeth V Adamov, Ross D Zafonte
With the continued advancement in technology, such as increasingly sophisticated neuroimaging parameters, and the ongoing development of various scientific fields, like serum and blood biomarkers, genetics, and physiology, traumatic brain injury (TBI) research is a dynamic field of study. TBI remains a significant public health concern and research has continued to grow exponentially over the past decade. This review provides an overview of the frontiers of TBI research, from sports concussion to severe TBI, from acute and subacute injury to long-term/chronic outcomes, from assessment and management to prognosis, specifically examining recent neuroimaging, biomarkers, genetics, and physiologic studies...
May 2017: Physical Medicine and Rehabilitation Clinics of North America
https://www.readbyqxmd.com/read/28390510/acute-management-of-moderate-severe-traumatic-brain-injury
#17
REVIEW
Wittstatt Alexandra Whitaker-Lea, Alex B Valadka
Traumatic brain injury (TBI) continues to be a major public health problem. Proposed treatments have not withstood testing in clinical trials because of failure to account for different types of TBI and other weaknesses in trial design. Management goals continue to be prevention and prompt treatment of secondary insults (hypotension, hypoxia, and other physiologic derangements). This goal is best accomplished by careful attention to airway, breathing, circulation, and basic principles of intensive care unit management...
May 2017: Physical Medicine and Rehabilitation Clinics of North America
https://www.readbyqxmd.com/read/28382259/traumatic-tension-pneumocephalus-two-cases-and-comprehensive-review-of-literature
#18
REVIEW
Promod Pillai, Rohit Sharma, Larami MacKenzie, Eugene F Reilly, Paul R Beery, Thomas J Papadimos, Stanislaw Peter A Stawicki
Although traumatic pneumocephalus is not uncommon, it rarely evolves into tension pneumocephalus (TP). Characterized by the presence of increasing amounts of intracranial air and concurrent appearance or worsening neurological symptoms, TP can be devastating if not recognized and treated promptly. We present two cases of traumatic TP and a concise review of literature on this topic. Two cases of traumatic TP are presented. In addition, a literature search revealed 20 additional cases, of which 18 had sufficient information for inclusion...
January 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28362667/implementation-strategies-in-pediatric-neurocritical-care
#19
Christopher Markham, Enola K Proctor, Jose A Pineda
PURPOSE OF REVIEW: Brain-directed critical care for children is a relatively new area of subspecialization in pediatric critical care. Pediatric neurocritical care teams combine the expertise of neurology, neurosurgery, and critical care medicine. The positive impact of delivering specialized care to pediatric patients with acute neurological illness is becoming more apparent, but the optimum way to implement and sustain the delivery of this is complicated and poorly understood. We aim to provide emerging evidence supporting that effective implementation of pediatric neurocritical care pathways can improve patient survival and outcomes...
June 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28336376/effect-of-anesthetics-on-microglial-activation-and-nanoparticle-uptake-implications-for-drug-delivery-in-traumatic-brain-injury
#20
Gokul Kannan, Siva P Kambhampati, Sapna R Kudchadkar
Traumatic brain injury (TBI) is a serious public health problem, often with devastating consequences for patients and their families. Affordable and timely therapies can have a substantial impact on outcomes in severe TBI. Despite the common use of sedatives and anesthetics in the acute phase of TBI management, their effect on glial cells is not well understood. We investigated the effect of a commonly used sedative, pentobarbital, on glial cells and their uptake of nanoparticles. First, we studied how pentobarbital affects BV2 mouse microglial cells in culture...
March 21, 2017: Journal of Controlled Release: Official Journal of the Controlled Release Society
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