Early and Late Systemic Hypotension as a Frequent and Fundamental Source of Cerebral Ischemia Following Severe Brain Injury in the Traumatic Coma Data Bank

Chesnut, Randall M.; Marshall, Sharon Bowers; Piek, J.; Blunt, Barbara A.; Klauber, Melville R.; Marshall, Lawrence F.

doi:10.1007/978-3-7091-9302-0_21

Cited by 215 publications

(174 citation statements)

References 5 publications

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“…In one of the first reports of the effects of posttraumatic hypotensive or hypoxemic insults after TBI, Miller & Becker (1982) observed that hypotension (systolic blood pressure < 90 mmHg) or hypoxemia (PaO 2 < 60 mmHg) doubled mortality rates and markedly reduced the percentage of good recovery/moderate disability patients. Chesnut et al (1993) confirmed these observations in a larger series of patients and also observed that, while combined hypoxemic and hypotensive insults were associated with worsened outcome than either insult alone, hypotension alone was a more important predicator of outcome than hypoxemia alone. In a retrospective analysis of data from more than 1,200 TBI patients, Luerssen and Klauber (1989) observed that reductions in mean arterial blood pressure of as little as 10 mmHg were associated with a two-fold increase in mortality in TBI patients.…”

Section: Mtbi Followed By Hemorrhagic Hypotensionsupporting

confidence: 76%

Mission Connect Mild TBI Translational Research Consortium

Robertson¹,

DeWitt²

2012

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Section: Mtbi Followed By Hemorrhagic Hypotensionsupporting

confidence: 76%

Mission Connect Mild TBI Translational Research Consortium

Robertson¹,

DeWitt²

2012

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“…34 It has been also shown in clinical studies that posttraumatic hypoxia is associated with poor neurologic outcomes and a prolonged recovery period. 35 The adverse effect of hypoxia on the protection against secondary brain damage argues strongly for an importance of ATP in the healing process after brain injury.…”

Section: Discussionmentioning

confidence: 99%

Low-Level Laser Therapy Effectively Prevents Secondary Brain Injury Induced by Immediate Early Responsive Gene X-1 Deficiency

Zhang

Zhou

Hamblin

et al. 2014

J Cereb Blood Flow Metab

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A mild insult to the brain can sometimes trigger secondary brain injury, causing severe postconcussion syndrome, but the underlying mechanism is ill understood. We show here that secondary brain injury occurs consistently in mice lacking immediate early responsive gene X-1 (IEX-1), after a gentle impact to the head, which closely simulates mild traumatic brain injury in humans. The pathologic lesion was characterized by extensive cell death, widespread leukocyte infiltrates, and severe tissue loss. On the contrary, a similar insult did not induce any secondary injury in wild-type mice. Strikingly, noninvasive exposure of the injured head to a low-level laser at 4 hours after injury almost completely prevented the secondary brain injury in IEX-1 knockout mice. The low-level laser therapy (LLLT) suppressed proinflammatory cytokine expression like interleukin (IL)-1b and IL-6 but upregulated TNF-a. Moreover, although lack of IEX-1 compromised ATP synthesis, LLLT elevated its production in injured brain. The protective effect of LLLT may be ascribed to enhanced ATP production and selective modulation of proinflammatory mediators. This new closed head injury model provides an excellent tool to investigate the pathogenesis of secondary brain injury as well as the mechanism underlying the beneficial effect of LLLT.

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“…In response to this question, only 27% (n = 18) indicated they had knowledge Hypotension occurs in 35% of TBI patients and increases mortality 50% to 150%. 49 Hypotension is especially harmful in TBI patients because of impaired cerebral autoregulation 3 and results in decreased CPP. 50 Episodes of desaturation in TBI patients are associated with increased mortality rates and poor outcomes for patients.…”

Section: Demographic Datamentioning

confidence: 99%

Judgments of Critical Care Nurses About Risk for Secondary Brain Injury

McNett

Doheny

Sedlak

et al. 2010

American Journal of Critical Care

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Background Interdisciplinary care for patients with traumatic brain injury focuses on treating the primary brain injury and limiting further brain damage from secondary injury. Intensive care unit nurses have an integral role in preventing secondary brain injury; however, little is known about factors that influence nurses’ judgments about risk for secondary brain injury. Objective To investigate which physiological and situational variables influence judgments of intensive care unit nurses about patients’ risk for secondary brain injury, management solely with nursing interventions, and management by consulting another member of the health care team. Methods A multiple segment factorial survey design was used. Vignettes reflecting the complexity of real-life scenarios were randomly generated by using different values of each independent variable. Surveys containing the vignettes were sent to nurses at 2 level I trauma centers. Multiple regression was used to determine which variables influenced judgments about secondary brain injury. Results Judgments about risk for secondary brain injury were influenced by a patient’s oxygen saturation, intracranial pressure, cerebral perfusion pressure, mechanism of injury, and primary diagnosis, as well as by nursing shift. Judgments about interventions were influenced by a patient’s oxygen saturation, intracranial pressure, and cerebral perfusion pressure and by nursing shift. The initial judgments made by nurses were the most significant variable predictive of follow-up judgments. Conclusions Nurses need standardized, evidence-based content for management of secondary brain injury in critically ill patients with traumatic brain injury.

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Early and Late Systemic Hypotension as a Frequent and Fundamental Source of Cerebral Ischemia Following Severe Brain Injury in the Traumatic Coma Data Bank

Cited by 215 publications

References 5 publications

Mission Connect Mild TBI Translational Research Consortium

Mission Connect Mild TBI Translational Research Consortium

Low-Level Laser Therapy Effectively Prevents Secondary Brain Injury Induced by Immediate Early Responsive Gene X-1 Deficiency

Judgments of Critical Care Nurses About Risk for Secondary Brain Injury

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