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Management of Severe Head Injury

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10761. Therapeutic effect of mild hypothermia on severe traumatic head injury. (Abstract)

Therapeutic effect of mild hypothermia on severe traumatic head injury. To investigate the therapeutic effect of mild hypothermia on severe traumatic brain injury.Eighty-six in-patients with severe traumatic brain injury treated ordinarily were consecutively randomized into two groups: a hypothermia group (n=43) and a normothermia group (the control group, n=43). In the hypothermia group, the core temperature (i.e., nasopharyngeal or brain temperature) of the patient was reduced (...) and renal malfunction, were managed without severe sequelae.Mild hypothermia is a safe and effective therapeutic method, which can lower the extradural pressure, increase the serum superoxide dismutase and improve the neurological outcomes without severe complications in the patients with severe traumatic brain injury.

2005 Chinese journal of traumatology = Zhonghua chuang shang za zhi / Chinese Medical Association Controlled trial quality: uncertain

10762. Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. (Abstract)

Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. : Intracranial hypertension after severe head injury is associated with case fatality, but there is no sound evidence that monitoring of intracranial pressure (ICP) and targeted management of cerebral perfusion pressure (CPP) improve outcome, despite widespread recommendation by experts in the field. The purpose was to determine the effect of ICP/CPP-targeted intensive care (...) on functional outcome and therapy intensity levels after severe head injury.: Retrospective cohort study with prospective assessment of outcome.: Two level I trauma centers in The Netherlands from 1996 to 2001.: Three hundred thirty-three patients who had survived and remained comatose for >24 hrs, from a total of 685 consecutive severely head-injured adults.: In center A (supportive intensive care), mean arterial pressure was maintained at approximately 90 mm Hg, and therapeutic interventions were based

2005 Critical Care Medicine

10763. Association between alcohol and mortality in patients with severe traumatic head injury. Full Text available with Trip Pro

Association between alcohol and mortality in patients with severe traumatic head injury. Admission blood alcohol concentration (BAC) is associated with in-hospital death in patients with severe brain injury from blunt head trauma.Retrospective cohort study.Academic level I trauma center in Toronto, Ontario.Using trauma registry data, between January 1, 1988, and December 31, 2003, we identified 1158 consecutive patients with severe brain injury from blunt head trauma.There was no active (...) ). These associations were all statistically significant after adjusting for demographic data and injury factors using logistic regression analysis. The odds ratio for death was 0.76 (95% confidence interval, 0.52-0.98) for low to moderate BAC compared with no BAC. The odds ratio for death was 1.73 (95% confidence interval, 1.05-2.84) for high BAC compared with no BAC.Low to moderate BAC may be beneficial in patients with severe brain injury from blunt head trauma. In contrast, high BAC seems to have a deleterious

2006 Archives of Surgery

10764. An Italian survey of severe head trauma management during extracranial surgery. (Abstract)

An Italian survey of severe head trauma management during extracranial surgery. Anaesthetic drugs and procedures interfere with secondary brain injury following severe head trauma, yet studies regarding the anaesthetic management of these patients are lacking. We investigated the behaviour of Italian anaesthetists regarding this topic.A questionnaire investigating the approach to a patient with severe head trauma requiring an urgent splenectomy for ruptured spleen was sent to 250 Italian (...) % of the responders advocated the use of blood or blood products to optimize peripheral oxygen transport.More widespread knowledge of certain areas of severe head trauma management such as early tracheal intubation, avoidance of prophylactic hyperventilation, adequate invasive monitoring, appropriate use of blood products, and timing of transfer to hospitals with neurosurgical facilities is needed.

2005 European Journal of Anaesthesiology

10765. The role of high frequency oscillatory ventilation in the management of children with severe traumatic brain injury and concomitant lung pathology. (Abstract)

The role of high frequency oscillatory ventilation in the management of children with severe traumatic brain injury and concomitant lung pathology. To report the use of high frequency oscillatory ventilation (HFOV) in two children with severe traumatic brain injury and concurrent lung pathology where conventional mechanical ventilation was ineffective.: Case report.Regional intensive care unit in a pediatric teaching hospital.Two severely head-injured children (both with postresuscitation (...) Glasgow Coma Scores of 3), one of whom was age 11 yrs and developed an invasive fungal (rhizomucor) pneumonia, while the other age 5 yrs had bilateral lung contusions. Both were treated according to local head injury guidelines, which included conventional ventilation. Despite increasing conventional ventilatory support, CO2 removal became problematic in both cases, making the intracranial pressure control and consequent maintenance of adequate cerebral perfusion pressure difficult. In both patients

2008 Pediatric Critical Care Medicine

10766. The implications of NICE guidelines on the management of children presenting with head injury. Full Text available with Trip Pro

The implications of NICE guidelines on the management of children presenting with head injury. NICE guidelines for the management of head injury were published in June 2003. Their recommendations differ markedly from previous guidelines published by the Royal College of Surgeons (RCS). In place of skull radiography and admission, computed tomography (CT) is advocated. The impact of these guidelines on service provision in the UK is unknown.Data on all clinical correlates of children presenting (...) with any severity of head injury was collected in three hospitals in the northwest of England. The current skull radiograph (SXR), CT scan, and admission rates were determined. The rates of SXR, CT scan, and admission that should have occurred when following either the RCS or NICE guidelines were then determined.Data from 10 965 patients who attended three hospitals between February 2000 and August 2002 was studied. Twenty five per cent of patients received a SXR, 0.9% a CT scan, and 3.7% were admitted

2004 Archives of Disease in Childhood

10767. Prospective validation of a proposal for diagnosis and management of patients attending the emergency department for mild head injury. Full Text available with Trip Pro

of Neurosurgical Societies on mild head injury from an emergency department perspective.In a three year period, 5578 adolescent and adult subjects were prospectively recruited and managed according to the proposed protocol. Outcome measures were: (a) any post-traumatic lesion; (b) need for neurosurgical intervention; (c) unfavourable outcome (death, permanent vegetative state or severe disability) after six months. The predictive value of a model based on five variables (Glasgow coma score, clinical findings (...) Prospective validation of a proposal for diagnosis and management of patients attending the emergency department for mild head injury. In mild head injury, predictors to select patients for computed tomography (CT) and/or to plan proper management are needed. The strength of evidence of published recommendations is insufficient for current use. We assessed the diagnostic accuracy and the clinical validity of the proposal of the Neurotraumatology Committee of the World Federation

2004 Neurosurgery and Psychiatry

10768. Interventions and service need following mild and moderate head injury: the Oxford Head Injury Service. (Abstract)

Interventions and service need following mild and moderate head injury: the Oxford Head Injury Service. To describe the interventions given by the Oxford Head Injury Service (OXHIS) to patients seen after head injury, predominantly mild or moderate, over the first six months after their injuries.Descriptive data of the amounts of early intervention provided by OXHIS in relation to severity of head injury and the amount of service need identified at six month follow-up.OXHIS aimed to register (...) all patients aged 16-65 with a head injury of any severity, resident in Oxfordshire. It contacted and provided interventions for a random half of those registered at 7-10 days post-injury as part of a randomized controlled trial to investigate the effectiveness of early follow-up. At six months post-injury, independent assessment of all those registered was undertaken to evaluate outcome and identify continuing service needs.The data come from the 579 patients (of the 1156 registered), randomized

1997 Clinical rehabilitation Controlled trial quality: uncertain

10769. Hypothermia and hyperbaric oxygen as treatment modalities for severe head injury. (Abstract)

Hypothermia and hyperbaric oxygen as treatment modalities for severe head injury. Moderate systemic hypothermia has been shown to improve neurologic outcomes in both fluid-percussion and cortical contusion models of experimental brain injury. Based upon initial clinical work, it was concluded that at temperatures < 32 degrees C, patients with severe brain injury were at increased risk of ventricular arrhythmias, and that rapid rewarming immediately postinjury predisposed to intracranial (...) pressure increases. Subsequent clinical studies of moderate hypothermia (32 degrees C) for 24- to 48-hr duration with slow rewarming in human brain injury showed indications of neurologic improvement and a low incidence of hypothermia-related complications. Based upon the strengths of both laboratory and clinical data, a multicenter (nine centers), randomized, prospective trial testing moderate systemic hypothermia in patients with severe brain injury has been organized. This trial, funded by National

1995 New horizons (Baltimore, Md.)

10770. Prevention of acute gastrointestinal complications after severe head injury: a controlled trial of cimetidine prophylaxis. (Abstract)

Prevention of acute gastrointestinal complications after severe head injury: a controlled trial of cimetidine prophylaxis. Cimetidine prophylaxis significantly reduced the risk of gastrointestinal bleeding after severe head injury in this prospective, double-blind clinical trial. Cimetidine effectively reduced both the volume and the acidity of gastric secretions after brain injury without producing adverse side effects. The most common endoscopic finding was superficial, erosive, mucosal (...) lesions in the proximal stomach. Cimetidine prophylaxis was not shown to reduce the incidence of these lesions in this study but did diminish their severity and the likelihood that they would complicate the management of these patients.

1980 American journal of surgery

10771. Outcome after severe head injury treated by an integrated trauma system. Full Text available with Trip Pro

Outcome after severe head injury treated by an integrated trauma system. To describe outcome after treatment of severe head injury within an integrated trauma system.A retrospective analysis of all patients with severe head injury admitted to the Royal London Hospital by the Helicopter Emergency Medical Service (HEMS) between 1991 and 1994. Type of injury was defined on initial computed tomography of the head and outcomes assessed 12 months after injury using the Glasgow outcome score.6.5 (...) % of HEMS patients had long term severe disability (severe disability or persistent vegetative state on the outcome score); 34.5% made a good recovery.The concern that a large number of severely disabled long term survivors might result as a consequence of this system of trauma management is not confirmed. The case mix of severity of extracranial injuries in these patients makes comparison with other published series difficult, but these data fit the hypothesis that pre-hospital correction of hypoxia

1999 Journal of accident & emergency medicine

10772. Effect of THAM upon outcome in severe head injury: a randomized prospective clinical trial. (Abstract)

Effect of THAM upon outcome in severe head injury: a randomized prospective clinical trial. Although mortality and morbidity rates from head injury have been reduced substantially by improved prehospital interventions, intensive care, and aggressive management of intracranial pressure (ICP), successful treatment of the primary brain injury has been elusive. In experimental models, tromethamine (THAM) has been effective in treating head injury; this drug acts by entering the cerebrospinal fluid (...) compartment, reducing cerebral acidosis and ICP, and reversing the adverse effects of prophylactic hyperventilation on early recovery. In this randomized prospective clinical trial, THAM was studied to determine if it had beneficial effects in the early management of severe head injuries and if the adverse effects of hyperventilation could be prevented. A total of 149 patients with severe head injury (Glasgow Coma Scale scores of < or = 8) were randomly assigned to either a control or a THAM group. Both

1993 Journal of neurosurgery Controlled trial quality: uncertain

10773. Improving the outcome of severe head injury with the oxygen radical scavenger polyethylene glycol-conjugated superoxide dismutase: a phase II trial. (Abstract)

Improving the outcome of severe head injury with the oxygen radical scavenger polyethylene glycol-conjugated superoxide dismutase: a phase II trial. Formation of the oxygen radical superoxide anion is one of the final events of several metabolic pathways in the cascade that leads to delayed neuronal death after traumatic or ischemic brain injury. In the laboratory, scavenging of the superoxide anion with native superoxide dismutase (SOD) or polyethylene glycol (PEG)-conjugated SOD (PEG-SOD) has (...) been shown to be beneficial in several types of traumatic and ischemic injury. Accordingly, PEG-SOD was utilized in a randomized controlled Phase II trial to evaluate its safety and efficacy in severely head-injured patients with a Glasgow Coma Scale score of 8 or less. At two institutions, 104 patients were randomly assigned to receive either placebo or PEG-SOD (2000, 5000, or 10,000 U/kg) intravenously as a bolus, an average of 4 hours after injury. Prognostic factors were evenly distributed

1993 Journal of neurosurgery Controlled trial quality: uncertain

10774. Prevention of secondary ischemic insults after severe head injury. (Abstract)

Prevention of secondary ischemic insults after severe head injury. The purpose of this study was to compare the effects of two acute-care management strategies on the frequency of jugular venous desaturation and refractory intracranial hypertension and on long-term neurologic outcome in patients with severe head injury.Randomized clinical trial.Level I trauma hospital.One hundred eighty-nine adults admitted in coma because of severe head injury.Patients were assigned to either cerebral blood (...) the injury that occurred in the ICP-targeted group. The beneficial effects of the CBF-targeted protocol may have been offset by a five-fold increase in the frequency of adult respiratory distress syndrome.Secondary ischemic insults caused by systemic factors after severe head injury can be prevented with a targeted management protocol. However, potential adverse effects of this management strategy may offset these beneficial effects.

1999 Critical care medicine Controlled trial quality: uncertain

10775. Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial. Full Text available with Trip Pro

Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial. Recently, a renewed emphasis has been placed on managing severe head injury by elevating cerebral perfusion pressure (CPP), which is defined as the mean arterial pressure minus the intracranial pressure (ICP). Some authors have suggested that CPP is more important in influencing outcome than (...) > or = 20 mm Hg) either initially or during neurological deterioration. There was no correlation with the CPP as long as the CPP was greater than 60 mm Hg.Treatment protocols for the management of severe head injury should emphasize the immediate reduction of raised ICP to less than 20 mm Hg if possible. A CPP greater than 60 mm Hg appears to have little influence on the outcome of patients with severe head injury.

2000 Journal of neurosurgery Controlled trial quality: uncertain

10776. Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury. Full Text available with Trip Pro

flow (CBF) and increase intracranial pressure (ICP). In a recent randomized trial of two head-injury management strategies (ICP-targeted and CBF-targeted), a fivefold increase in the incidence of ARDS was observed in the CBF-targeted group.Injury severity, physiological data, and treatment data in 18 patients in whom ARDS had developed were compared with the remaining 171 patients in the randomized trial in whom it had not developed. Logistic regression analysis was used to study the interaction (...) Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury. The factors involved in the development of adult respiratory distress syndrome (ARDS) after severe head injury were studied. The presence of ARDS complicates the treatment of patients with severe head injury, both because hypoxia causes additional injury to the brain and because therapies that are used to protect the lungs and improve oxygenation in patients with ARDS can reduce cerebral blood

2001 Journal of neurosurgery Controlled trial quality: uncertain

10777. Prospective survey on neurosurgical intensive care for patients with severe head injury. (Abstract)

Prospective survey on neurosurgical intensive care for patients with severe head injury. To prospectively compare the clinical outcome of intensive care therapy (ICT) with that of conventional care therapy (CCT) in severe head injured patients.Patients with severe head injury were assigned randomly into Group ICT and Group CCT, 100 patients in each group. Patients in Group ICT accepted intensive care therapy in neurosurgical intensive care (NIC) unit for the first 2 weeks after admission, while (...) ), while the mortality in the same range of age was decreased in Group ICT (chi(2)=5.28, P<0.05). The mortality was reduced significantly in patients with GCS for 6-8 on admission (chi(2)=8.47, P<0.01) and in patients with the level of brain stem injured below mesencephalon (chi(2)=4.15, P<0.05). ICT would improve the outcome in patients undergoing conservative therapy only (chi(2)=13.13, P<0.01).NIC plays an important role in assessing the neurological state, guiding management, evaluating curative

2001 Chinese journal of traumatology = Zhonghua chuang shang za zhi / Chinese Medical Association Controlled trial quality: uncertain

10778. Immune suppression and isolated severe head injury: a significant clinical problem. (Abstract)

Immune suppression and isolated severe head injury: a significant clinical problem. In the developed world, trauma is the principal cause of death under the age of 40 and is the third largest overall killer. In the UK, approximately 25,000 people die each year as a result of major injury, 25% as a result of head injuries alone. Despite improved diagnosis and management, infection remains the commonest complication in those patients surviving the initial injury. Some 5% are reported to die (...) as a result of septic complications. Prolonged periods of intensive care and respiratory support predispose to infective respiratory complications. These patients in the absence of significant systemic injury and, as a result of severe head injury, are unable to mount an effective immune response. This literature review examines the changes that have been reported to occur in the immune system following isolated severe head injury and explores the relationship these changes may have to the increased

2003 British Journal of Neurosurgery

10779. Fluid resuscitation of patients with multiple injuries and severe closed head injury: experience with an aggressive fluid resuscitation strategy. (Abstract)

Fluid resuscitation of patients with multiple injuries and severe closed head injury: experience with an aggressive fluid resuscitation strategy. Despite increasing experimental and clinical evidence to the contrary, a dichotomy of management strategies of the patient with multiple injuries still exists, based on the presence or absence of traumatic brain injury. Many still advocate fluid restriction or small volume resuscitation if traumatic brain injury is present.To demonstrate results (...) of aggressive fluid resuscitation in a prospective case series of patients with multiple injuries and with severe head injury.Thirty-four patients with Glasgow Coma Scale score < or = 8 and Injury Severity Score > or = 16 were enrolled into the study over a period of 18 months. Fluid resuscitation was guided in part by cerebral perfusion pressures (mean cerebral perfusion pressures > 80) as well as by hemodynamic monitoring and evidence of end organ perfusion. Overall fluid intake, intensive care unit fluid

2000 Journal of Trauma Controlled trial quality: uncertain

10780. Reduction in mortality from severe head injury following introduction of a protocol for intensive care management. Full Text available with Trip Pro

Reduction in mortality from severe head injury following introduction of a protocol for intensive care management. To determine the effect of an intensive care management protocol on the intensive care unit (ICU) and hospital mortality of severely head-injured patients, we designed a longitudinal observational study of all patients admitted with a head injury between 1992 and 2000.A computerized patient database was used to identify all patients with severe head injury admitted to the ICU (...) a significant increase in the median APACHE II score (14 vs 18) of patients admitted after implementation of the protocol. The median ICU and hospital length of stay remained constant over the study period.The introduction of an evidence-based protocol to guide the ICU management of patients with severe head injury has been associated with a significant reduction in both ICU and hospital mortality.

2004 British Journal of Anaesthesia

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