Applying Cerebral Hypothermia and Brain Oxygen Monitoring in Treating Severe Traumatic Brain Injury

Lee, Han Chung; Chuang, Hao Che; Cho, Der Yang; Cheng, Kuang Fu; Lin, Pao Hsuan; Chen, Chun-Chung

doi:10.1016/j.wneu.2010.06.019

Cited by 55 publications

(48 citation statements)

References 23 publications

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“…For example, concurrent monitoring of brain tissue oxygen and administration of mild hypothermia synergistically assists in reducing ICP post-TBI; decreasing ICP may limit inflammatory damage occurring later in TBI pathogenesis [52]. Identifying cases of TBI where the use of hypothermia is warranted is vital.…”

Section: Prophylactic Hypothermia and Hyperbaric Oxygen Therapy (Hbot)mentioning

confidence: 99%

Traumatic Brain Injury Pathophysiology and Treatments: Early, Intermediate, and Late Phases Post-Injury

Algattas

Huang

2013

IJMS

229

178

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Traumatic Brain Injury (TBI) affects a large proportion and extensive array of individuals in the population. While precise pathological mechanisms are lacking, the growing base of knowledge concerning TBI has put increased emphasis on its understanding and treatment. Most treatments of TBI are aimed at ameliorating secondary insults arising from the injury; these insults can be characterized with respect to time post-injury, including early, intermediate, and late pathological changes. Early pathological responses are due to energy depletion and cell death secondary to excitotoxicity, the intermediate phase is characterized by neuroinflammation and the late stage by increased susceptibility to seizures and epilepsy. Current treatments of TBI have been tailored to these distinct pathological stages with some overlap. Many prophylactic, pharmacologic, and surgical treatments are used post-TBI to halt the progression of these pathologic reactions. In the present review, we discuss the mechanisms of the pathological hallmarks of TBI and both current and novel treatments which target the respective pathways.

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Section: Prophylactic Hypothermia and Hyperbaric Oxygen Therapy (Hbot)mentioning

confidence: 99%

Traumatic Brain Injury Pathophysiology and Treatments: Early, Intermediate, and Late Phases Post-Injury

Algattas

Huang

2013

IJMS

229

178

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“…The effect of osmotherapy to control ICP can be guided by PbtO 2 data [75 -78]. Other ICP therapies (hypothermia [79][80][81][82][83], barbiturates [84,85], or decompressive craniectomy [86][87][88]) can be guided by PbtO 2 data. In patients receiving hypothermia PbtO 2 monitors may detect deleterious effects associated with a change in CO 2 affinity or with shivering [43, 83,89,90].…”

Section: Does Pbto 2 Monitoring Help Guide Management?mentioning

confidence: 99%

Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Oddo

Bösel

2014

Neurocrit Care

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Maintenance of adequate oxygenation is a mainstay of intensive care, however, recommendations on the safety, accuracy, and the potential clinical utility of invasive and non-invasive tools to monitor brain and systemic oxygenation in neurocritical care are lacking. A literature search was conducted for English language articles describing bedside brain and systemic oxygen monitoring in neurocritical care patients from 1980 to August 2013. Imaging techniques e.g., PET are not considered. A total of 281 studies were included, the majority described patients with traumatic brain injury (TBI). All tools for oxygen monitoring are safe. Parenchymal brain oxygen (PbtO2) monitoring is accurate to detect brain hypoxia, and it is recommended to titrate individual targets of cerebral perfusion pressure (CPP), ventilator parameters (PaCO2, PaO2), and transfusion, and to manage intracranial hypertension, in combination with ICP monitoring. SjvO2 is less accurate than PbtO2. Given limited data, NIRS is not recommended at present for adult patients who require neurocritical care. Systemic monitoring of oxygen (PaO2, SaO2, SpO2) and CO2 (PaCO2, end-tidal CO2) is recommended in patients who require neurocritical care.

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“…Three studies concluded that TH improves neurological outcome with statistical significance (Smrčka et al , ; Inamasu et al , ; Lee et al , ). Lee et al () reported a favourable outcome in 71·4% of patients managed with TH in conjunction with P ti O 2 (brain tissue oxygenation)‐guided management of cerebral perfusion pressure (CPP), 60% in the TH group without P ti O 2 ‐guided management and 50% in the normothermia group ( p = 0·04). However, the use of three treatment strategies makes it difficult to distinguish whether the improved outcomes were because of the guided CPP management or TH, and the sample size is limited.…”

Section: Methodsmentioning

confidence: 99%

Therapeutic hypothermia in patients following traumatic brain injury: a systematic review

Dunkley

McLeod

2016

Nursing in Critical Care

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Applying Cerebral Hypothermia and Brain Oxygen Monitoring in Treating Severe Traumatic Brain Injury

Cited by 55 publications

References 23 publications

Traumatic Brain Injury Pathophysiology and Treatments: Early, Intermediate, and Late Phases Post-Injury

Traumatic Brain Injury Pathophysiology and Treatments: Early, Intermediate, and Late Phases Post-Injury

Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Therapeutic hypothermia in patients following traumatic brain injury: a systematic review

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