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transfusion traumatic brain injury

Jeffrey L Carson, Simon J Stanworth, Nareg Roubinian, Dean A Fergusson, Darrell Triulzi, Carolyn Doree, Paul C Hebert
BACKGROUND: There is considerable uncertainty regarding the optimal haemoglobin threshold for the use of red blood cell (RBC) transfusions in anaemic patients. Blood is a scarce resource, and in some countries, transfusions are less safe than others because of a lack of testing for viral pathogens. Therefore, reducing the number and volume of transfusions would benefit patients. OBJECTIVES: The aim of this review was to compare 30-day mortality and other clinical outcomes in participants randomized to restrictive versus liberal red blood cell (RBC) transfusion thresholds (triggers) for all conditions...
October 12, 2016: Cochrane Database of Systematic Reviews
Kai Oliver Jensen, Leonhard Held, Andrea Kraus, Frank Hildebrand, Philipp Mommsen, Ladislav Mica, Guido A Wanner, Peter Steiger, Rudolf M Moos, Hans-Peter Simmen, Kai Sprengel
BACKGROUND: Although under discussion, induced hypothermia (IH) is an established therapy for patients with cardiac arrest or traumatic brain injuries. The influences on coagulopathy and bleeding tendency in severely injured patients (SIP) with concomitant traumatic brain injury are most widely unclear. Therefore, the aim of this study was to quantify the effect of mild IH in SIP with concomitant severe traumatic brain injuries on transfusion rate and mortality. METHODS: In this retrospective multi-centre study, SIP from three European level-1 trauma centres with an ISS ≥16 between 2009 and 2011 were included...
October 6, 2016: European Journal of Medical Research
Sarah Travers, Simon Martin, N Scott Litofsky
BACKGROUND: Anaemia in traumatic brain injury (TBI) is frequently encountered. Neurosurgical texts continue to recommend transfusion for hematocrit below 30%, despite clear evidence to do so. Transfusion should increase oxygen delivery to the brain, but it may also increase morbidity and mortality. METHODS: This study reviewed the relevant literature to better understand the risks of anaemia and benefits of correction of anaemia by transfusion. RESULTS: Of the 21 studies reviewed, eight found that anaemia was harmful to patients with TBI; five found no significant outcome; seven found transfusion was associated with higher rates of morbidity and mortality; two found that transfusion lowered mortality and increased brain tissue oxygen levels; and ten found no correlation between transfusion and outcome...
September 28, 2016: Brain Injury: [BI]
Imo P Aisiku, Jose-Miguel Yamal, Pratik Doshi, Julia S Benoit, Shankar Gopinath, Jerry C Goodman, Claudia S Robertson
BACKGROUND: Patients with severe traumatic brain injury (TBI) are at risk of the development of acute respiratory distress syndrome (ARDS). TBI and ARDS pathophysiologic mechanisms are known to independently involve significant inflammatory responses. The literature on the association between plasma inflammatory cytokines and ARDS in patients with TBI is sparse. METHODS: The study was a secondary analysis of the safety of a randomized trial of erythropoietin and transfusion threshold in patients with severe TBI...
2016: Critical Care: the Official Journal of the Critical Care Forum
James M Feeney, Elizabeth Santone, Monica DiFiori, Lilla Kis, Vijay Jayaraman, Stephanie C Montgomery
BACKGROUND: Falls represent the leading cause of traumatic brain injury in adults older than 65, with nearly one third experiencing a fall each year. Evidence suggests that up to 0.5% of anticoagulated patients suffer from ICH annually. Direct oral anticoagulants (DOACs) have become an increasingly popular alternative to warfarin for anticoagulation, however, there is a dearth of research regarding the safety of DOACs, in particular on the outcome of traumatic ICH while taking DOACs. METHODS: We queried our Trauma Quality Improvement Project registry for patients who presented with traumatic intracranial hemorrhage during anticoagulant use...
September 16, 2016: Journal of Trauma and Acute Care Surgery
Kevin F Yee, Andrew M Walker, Elaine Gilfoyle
Objective. There is increasing evidence of adverse outcomes associated with blood transfusions for adult traumatic brain injury patients. However, current evidence suggests that pediatric traumatic brain injury patients may respond to blood transfusions differently on a vascular level. This study examined the influence of blood transfusions and anemia on the outcome of pediatric traumatic brain injury patients. Design. A retrospective cohort analysis of severe pediatric traumatic brain injury (TBI) patients was undertaken to investigate the association between blood transfusions and anemia on patient outcomes...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
Joseph Carnevale, David J Segar, Benjamin Drapcho, Cody Doberstein, John F Morrison, Wael Asaad
INTRODUCTION: Annually in the United States, an estimated 1.7 million people experience traumatic brain injury (TBI), resulting in 1.4 million emergency department visits, 270 000 hospitalizations, and 53 000 deaths. The most common mass lesions associated with TBI are hematomas and contusions. Currently, there is no proven treatment protocol for contusion management. This retrospective study seeks to provide a more comprehensive assessment of the hemorrhagic progressions of contusions (HPC) by analyzing the rate at which contusions blossom depending on a variety of factors...
August 2016: Neurosurgery
Shahid Shafi, Ashley W Collinsworth, Kathleen M Richter, Hasan B Alam, Lance B Becker, Malcolm R Bullock, James M Ecklund, John Gallagher, Raj Gandhi, Elliott R Haut, Zachary L Hickman, Heidi Hotz, James McCarthy, Alex B Valadka, John Weigelt, John B Holcomb
No abstract text is available yet for this article.
October 2016: Journal of Trauma and Acute Care Surgery
Kevin R Carr, Michelle Rodriguez, Alex Ottesen, Joel Michalek, Colin Son, Vaibhav Patel, David Jimenez, Ali Seifi
BACKGROUND: Severe traumatic brain injury is associated with a multi-systemic response and changes in metabolic demand. Patients requiring intracranial pressure monitoring or cerebrospinal fluid diversion, often signifies a greater severity of injury. For this group, the association between RBC transfusion, transfusion thresholds, and clinical recovery is unknown. In this study, we studied the association between transfusion and clinical recovery for severe traumatic brain injury patients requiring external ventricular drain or intracranial pressure monitor placement...
October 2016: Neurocritical Care
Hosseinali Khalili, Aydin Omidvar, Fariborz Ghaffarpasand, Golnaz Yadollahikhales
OBJECTIVE: To determine the effects of application of anti-adhesive films (OrthoWrap™) in traumatic decompressive craniectomy on prevention of adhesion formation and facilitation of subsequent cranioplasty. METHODS: This was a retrospective cohort study being performed in ShahidRajaei hospital (Shiraz Level I trauma center) during a 12-month period (from March 2012 to April 2013) including 93 patients undergoing traumatic decompressivecraniectomy.Patients who received OrthoWrap™ during the initial craniectomy (n=44) were compared to those who did not (n=49)...
January 2016: Bulletin of Emergency and Trauma
Tahereh Orouji Jokar, Mazhar Khalil, Peter Rhee, Narong Kulvatunyou, Viraj Pandit, Terence O'Keeffe, Andrew Tang, Bellal Joseph
The use of 1:1:1 (packed red blood cells: fresh frozen plasma: platelets) transfusion ratio has been shown to improve survival in severely injured trauma patients. The aim of this study was to assess the outcomes in patients with traumatic brain injury (TBI) receiving 1:1:1 ratio-based blood product transfusion (RBT). We hypothesized that RBT improves survival in patients with TBI as only major injury. We performed a 3-year retrospective analysis of all patients with TBI as only major injury presenting to our Level I trauma center...
March 2016: American Surgeon
Nils Wagner, Annahita Akbarpour, Katharina Mörs, Maika Voth, Philipp Störmann, Birgit Auner, Mark Lehnert, Ingo Marzi, Borna Relja
BACKGROUND: The effect of alcohol consumption on inflammatory state and outcome in brain-injured patients remains controversial. We analyzed the influence of positive blood alcohol concentration (BAC) on inflammatory changes, inhospital complications, and mortality in traumatic brain injury (TBI) patients. PATIENTS AND METHODS: Patients with an Injury Severity Score (ISS) at least 16 and Abbreviated Injury Scale of head (AIS-head) at least 3 were included upon arrival in the emergency room and grouped according to positive BAC (>0...
September 2016: Shock
Patrick L Bosarge, Lauren Allen Raff, Gerald McGwin, Shannon L Carroll, Scott C Bellot, Enrique Diaz-Guzman, Jeffrey D Kerby
BACKGROUND: The use of extracorporeal membrane oxygenation (ECMO) in the trauma population has been reported to have a mortality benefit in patients with severe refractory hypoxic respiratory failure. This study compares the early initiation of ECMO for the management of severe adult respiratory distress syndrome (ARDS) versus a historical control immediately preceding the use of ECMO for trauma patients. METHODS: A retrospective study was conducted at a single verified Level I trauma center...
August 2016: Journal of Trauma and Acute Care Surgery
Aditya Vedantam, Jose-Miguel Yamal, Maria Laura Rubin, Claudia S Robertson, Shankar P Gopinath
OBJECT There is limited literature available to guide transfusion practices for patients with severe traumatic brain injury (TBI). Recent studies have shown that maintaining a higher hemoglobin threshold after severe TBI offers no clinical benefit. The present study aimed to determine if a higher transfusion threshold was independently associated with an increased risk of progressive hemorrhagic injury (PHI), thereby contributing to higher rates of morbidity and mortality. METHODS The authors performed a secondary analysis of data obtained from a recently performed randomized clinical trial studying the effects of erythropoietin and blood transfusions on neurological recovery after severe TBI...
March 4, 2016: Journal of Neurosurgery
Susan E Rowell, Kelly A Fair, Ronald R Barbosa, Jennifer M Watters, Eileen M Bulger, John B Holcomb, Mitchell J Cohen, Mohammad H Rahbar, Erin E Fox, Martin A Schreiber
Lactated Ringer's (LR) and normal saline (NS) are both used for resuscitation of injured patients. NS has been associated with increased resuscitation volume, blood loss, acidosis, and coagulopathy compared with LR. We sought to determine if pre-hospital LR is associated with improved outcome compared with NS in patients with and without traumatic brain injury (TBI). We included patients receiving pre-hospital LR or NS from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. Patients with TBI (Abbreviated Injury Scale [AIS] head ≥3) and without TBI (AIS head ≤2) were compared...
June 1, 2016: Journal of Neurotrauma
Carolyn M Hendrickson, Benjamin M Howard, Lucy Z Kornblith, Amanda S Conroy, Mary F Nelson, Hanjing Zhuo, Kathleen D Liu, Geoffrey T Manley, Michael A Matthay, Carolyn S Calfee, Mitchell J Cohen
BACKGROUND: Acute respiratory distress syndrome (ARDS) is common after traumatic brain injury (TBI) and is associated with worse neurologic outcomes and longer hospitalization. However, the incidence and associated causes of ARDS in isolated TBI have not been well studied. METHODS: We performed a subgroup analysis of 210 consecutive patients with isolated severe TBI enrolled in a prospective observational cohort at a Level 1 trauma center between 2005 and 2014. Subjects required endotracheal intubation and had isolated severe TBI defined by a head Abbreviated Injury Scale (AIS) score of 3 or greater and AIS score lower than 3 in all other categories...
June 2016: Journal of Trauma and Acute Care Surgery
Kui Song, Weichao Li, Min Li
Acute myeloid leukemia (AML) is an extremely rare complication that can be observed following mesenchymal stem cells (MSC) transplantation for traumatic brain injury (TBI). Few cases have been reported thus far. The present study reports a case of acute promyelocytic leukemia (APL) following MSC transplantation in a 36-year-old female. The patient presented with a fever and dermatorrhagia with an associative abnormal coagulation test almost 2 months after the MSC transplantation for TBI. The routine blood test, bone marrow (BM) test, and examination of the promyelocytic leukemia/retinoic acid receptor-α and mixed lineage leukemia chimeric genes confirmed the diagnosis of APL and disseminated intravascular coagulation (DIC)...
November 2015: Oncology Letters
Ihab Halaweish, Ted Bambakidis, Zhigang Chang, He Wei, Baoling Liu, Yongqing Li, Toby Bonthrone, Ashok Srinivasan, Tess Bonham, Kiril Chtraklin, Hasan B Alam
BACKGROUND: Combined traumatic brain injury (TBI) and hemorrhagic shock (HS) is highly lethal. In a nonsurvival model of TBI + HS, addition of high-dose valproic acid (VPA) (300 mg/kg) to hetastarch reduced brain lesion size and associated swelling 6 hours after injury; whether this would have translated into better neurologic outcomes remains unknown. It is also unclear whether lower doses of VPA would be neuroprotective. We hypothesized that addition of low-dose VPA to normal saline (NS) resuscitation would result in improved long-term neurologic recovery and decreased brain lesion size...
December 2015: Journal of Trauma and Acute Care Surgery
Sophie Rym Hamada, Tobias Gauss, Jakob Pann, Martin Dünser, Marc Leone, Jacques Duranteau
INTRODUCTION: Haemorrhagic shock is the leading cause of preventable death in trauma patients. The 2013 European trauma guidelines emphasise a comprehensive, multidisciplinary, protocol-based approach to trauma care. The aim of the present Europe-wide survey was to compare 2015 practice with the 2013 guidelines. METHODS: A group of members of the Trauma and Emergency Medicine section of the European Society of Intensive Care Medicine developed a 50-item questionnaire based upon the core recommendations of the 2013 guidelines, employing a multistep approach...
2015: Critical Care: the Official Journal of the Critical Care Forum
Santiago R Leal-Noval, Ángela Muñoz-Serrano, Victoria Arellano-Orden, Aurelio Cayuela, Manuel Muñoz-Gómez, Antonio Recio, Antonio Alcántara, Rosario Amaya-Villar, Manuel Casado-Méndez, Francisco Murillo-Cabezas
BACKGROUND: This 3-year prospective study examined the association between red blood cell transfusion (RBCT) and 1-year neurocognitive and disability levels in 309 patients with traumatic brain injury (TBI) admitted to the neurological intensive care unit (NICU). METHODS: Using a telephone interview-based survey, functional outcomes were assessed by the Glasgow Outcome Scale (GOS), Rancho Los Amigos Levels of Cognitive Functioning Scale (RLCFS), and Disability Rating Scale (DRS) and dichotomized as favorable and unfavorable (dependent variable)...
June 2016: Neurocritical Care
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