This systematic review found no convincing evidence that one sedative agent is more efficacious than another for improvement of patient-centered outcomes, intracranial pressure, or cerebral perfusion pressure in critically ill adults with severe traumatic brain injury. High bolus doses of opioids, however, have potentially deleterious effects on intracranial pressure and cerebral perfusion pressure. Adequately powered, high-quality, randomized controlled trials are urgently warranted.

Background: Evidence regarding longer-term psychiatric, psychological, and behavioural outcomes (for example, anxiety, mood disorders, depression, and attention disorders) following mild traumatic brain injury (mTBI) in children and adolescents has not been previously synthesized. Objective: To conduct a systematic review of the available evidence examining psychiatric, psychological, and behavioural outcomes following mTBI in children and adolescents.Materials and Methods: Nine electronic databases were systematically searched from 1980 to August 2014. Studies selected met the following criteria: original data; study design was a randomized controlled trial, quasi-experimental design, cohort or historical cohort study, case-control study, or cross-sectional study; exposure included mTBI (including concussion); population included children and adolescents (<19 years) at the time of mTBI, as well as a comparison group (for example, healthy children, children with orthopaedic injuries); and included psychiatric, psychological, or behavioural outcomes (for example, anxiety, mood disorders, depression, attention disorders). Two authors independently assessed the quality and level of evidence with the Downs and Black (DB) criteria and Oxford Centre of Evidence-Based Medicine (OCEBM) model, respectively, for each manuscript. Results: Of 9472 studies identified in the initial search, 30 were included and scored. Heterogeneity in methodology and injury definition precluded meta-analyses. The median methodological quality for all 30 studies, based on the DB criteria, was 15/33 (range 6 to 19). The highest level of evidence demonstrated by all reviewed studies was level 2b based on OCEBM criteria, with the majority (28/30 studies) classified at this level. Based on the literature included in this systematic review, psychological and psychiatric problems in children with a history of mTBI were found to be more prevalent when mTBI is Ré sultats : Sur les 9 472 études repérées dans la recherche initiale, 30 ont été incluses et notées. L'hétérogénéité de la méthodologie et la définition du traumatisme excluaient les méta-analyses. La qualité méthodologique moyenne pour les 30 études, selon les critères DB, était de 15/33 (écart 6-19). Le niveau le plus élevé des données probantes démontré par toutes les études examinées était le niveau 2b, selon les critères de l'OCEBM, la majorité des études (28/30) étant classées à ce niveau. D'après la littérature incluse dans cette revue systématique, les problèmes psychiatriques et psychologiques des enfants ayant des antécédents de TCCb se sont révélés plus prévalents quand le TCCb est associé à une hospitalisation, quand l'évaluation a lieu plus tôt dans la période de rétablissement (c.-à-d., qui se résout avec le temps), quand il y a de multiples TCCb passés, chez des personnes souffrant d'une maladie psychiatrique préexistante, quand les résultats sont basés sur la mémoire rétrospective, et quand le groupe de comparaison est formé d'enfants en santé non blessés (par oppositi...

The reported clinical presentation of tension pneumothorax depends on the ventilatory status of the patient. This may have implications for improving the diagnosis and treatment of this life-threatening disorder.

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Systematic review, level III.