Deep Sedation in Traumatic Brain Injury Patients

Abstract

Traumatic brain injury (TBI) is one of the leading causes of mortality and disability in adults. In cases of severe TBI, preventing secondary brain injury by managing intracranial hypertension during the acute phase is a critical treatment challenge. Among surgical and medical interventions to control intracranial pressure (ICP), deep sedation can provide comfort to patients and directly control ICP by regulating cerebral metabolism. However, insufficient sedation does not achieve the intended treatment goals, and excessive sedation can lead to fatal sedative-related complications. Therefore, it is important to continuously monitor and titrate sedatives by measuring the appropriate depth of sedation. In this review, we discuss the effectiveness of deep sedation, techniques to monitor the depth of sedation, and the clinical use of recommended sedatives, barbiturates, and propofol in TBI.

Machine Learning-Based Prognostic Models for Long-Term Care in Traumatic Brain Injury Patients Unable to Return Home: A Retrospective Analysis of ICU Admissions

“…In line with prior research, the top 18 features are all predictors of outcome after TBI (12,13,16,21,22,23,24,27,28,31). Age exhibits a signi cant (p < 0.001) difference between groups in Table 1, but the weak correlation (r=0.08) in Table 2 suggests a minor in uence on the No Return Home group.…”

“…Several studies have identi ed a range of predictive factors that may signi cantly in uence the outcomes of individuals with TBI in both acute and chronic stages. These factors include age (8, 9), sex (9,10), obesity (11), Glasgow Coma Scale (GCS), and pupil reactivity (12,13), computed tomography (CT) ndings (14,15), surgery (8, 16), injury severity (17)(18)(19)(20), vasopressor use (21), endotracheal tube intubation (22), intracranial pressure monitoring use (23), and hypnotic-sedative drug use (24). Therefore, establishing how to effectively utilize these feature variables for predicting outcomes is a crucial issue.…”

O impacto da ventilação mecânica na capacidade funcional de indivíduos com injúria cerebral em uma Unidade de Terapia Intensiva

“…Quando se trata de lesões traumáticas cranianas, a utilização de sedação é comumente aplicada devido ao controle da pressão intracraniana, pois evita a agitação do indivíduo, que se liga diretamente ao controle da PIC, porém quando se trata de tempos prolongados de sedação profunda, acaba resultando em declínio na evolução do mesmo, levando assim a resultados negativos em relação a função respiratória, hemodinâmica e capacidade motora (Choo et al, 2023). O presente estudo, corrobora com os achados na literatura, destacando que 95,1% dos indivíduos apresentaram um grau de sedação para RASS-5, indicando sedação profunda, dessa forma há grande possibilidade de acoplamento do indivíduo em ventilação mecânica, podendo gerar controle total do volume minuto, obtendo a normocapnia, contudo, mesmo com sedação plena, boa parte dos indivíduos foram ventilados em modos pressóricos, com oscilação de volume minuto, gerando hipocapnia ou hipercapnia totalizando 51,2% somados, tais situações podem gerar vasoconstrição ou vasodilatação cerebral de acordo com essas oscilações de PaCO2 (Matin et al, 2022).…”

Thromboelastometry-Based Prophylaxis for Venous Thromboembolism in the Acute Period Following Isolated Severe Traumatic Brain Injury

“…All patients were admitted to the intensive care unit and received recommended treatment during the acute period of TBI, including sedation and analgesia, invasive monitoring of hemodynamics, and intracranial pressure. 1 9) …”