EBIC-Guidelines for management of severe head injury in adults

Maas, Andrew I. R.; Dearden, Mark; Teasdale, G. M.; Braakman, R.; Cohadon, F; Iannotti, Fausto; Karimi, Abbi; Lapierre, F; Murray, Gordon D.; Öhman, Juha; Persson, Lennart; Servadei, Franco; Stocchetti, Nino; Unterberg, Andreas

doi:10.1007/bf01808823

Cited by 528 publications

(252 citation statements)

References 26 publications

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“…In contrast, brain tissue hypoxia (, 20 mm Hg) is associated with poor outcomes in the severely injured brain and oxygendirected strategies may improve outcomes (27,56,57). Although the optimal strategy to restore brain tissue oxygen tension to normal levels after brain injury is unknown, guidelines recommend targeting oxygenation values toward or within normal limits (58,59). In practice, based on the observation that brain tissue oxygen tension appears to be highly dependent on diffusion of dissolved oxygen (60), a common, albeit controversial, strategy in treating patients with traumatic brain injury is to use high FI O2 to achieve supraphysiological Pa O2 values to restore brain tissue oxygen levels (57).…”

Section: Perspectivesmentioning

confidence: 99%

Can We Optimize Long-Term Outcomes in Acute Respiratory Distress Syndrome by Targeting Normoxemia?

et al. 2014

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Since its original description in 1967, acute respiratory distress syndrome (ARDS) has been recognized as a devastating condition associated with significant morbidity and mortality. Advances in critical care medicine and ARDS management have led to a substantial increase in the number of ARDS survivors. Longterm cognitive impairment after critical illness is a significant public health concern. ARDS survivors frequently experience long-term cognitive impairment, as well as physical impairment, psychiatric morbidity, and reduced health-related quality of life. At present, no intensive care unit-based intervention has been proven to reduce the risk of long-term cognitive impairment after ARDS. To address the urgent need to identify strategies to preserve long-term health, investigators have advocated the measurement of short-and long-term outcomes in clinical trials. Maintaining adequate oxygen delivery to preserve organ function is of vital importance in ARDS management. The optimal target range for arterial oxygenation in ARDS remains unknown, due in part to the challenge to maintain adequate tissue oxygenation and to minimize harm, such as oxygen toxicity. An approach targeted to subnormal oxygenation values (partial pressure of arterial oxygen, 55-80 mm Hg) has emerged as a means to accomplish these aims. In this perspective, we critically evaluate this strategy from short-and long-term perspectives, with a focus on the potential long-term cognitive effects of the strategy. We conclude with a proposal to consider resetting the target range for arterial oxygenation higher (85-110 mm Hg) as a potential strategy to improve the long-term outcomes of ARDS survivors.

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Section: Perspectivesmentioning

confidence: 99%

Can We Optimize Long-Term Outcomes in Acute Respiratory Distress Syndrome by Targeting Normoxemia?

et al. 2014

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“…13 The question may be raised as to whether an intracranial blood volume-reducing therapy induced by hypothermia would be as effective as the established ICP-reducing therapies, which mainly act by reducing brain oedema. [24][25][26][27] Ongoing studies…”

Section: Can Alternative Protocols Improve Outcome?mentioning

confidence: 99%

“…18 The use of vasoconstrictors is an important component to counteract hypothermia-induced reduction in arterial pressure in the ongoing study by Clifton et al 29 Even though the use of vasoconstrictors is common in the treatment of TBI patients and favoured in traditional guidelines to increase cerebral perfusion pressure, 24,25 serious concerns have been raised since almost two decades in the use of these drugs in TBI patients, as they may compromise the circulation further of the hypoxic penumbra zone. 26,27 A recent study even showed that cerebral oxygenation was negatively affected by an infusion of norepinephrine in healthy subjects.…”

Section: Hypothermia-induced Use Of Vasoconstrictorsmentioning

confidence: 99%

Active cooling in traumatic brain‐injured patients: a questionable therapy?

Grände

Reinstrup

Romner

2009

Acta Anaesthesiol Scand

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Hypothermia is shown to be beneficial for the outcome after a transient global brain ischaemia through its neuroprotective effect. Whether this is also the case after focal ischaemia, such as following a severe traumatic brain injury (TBI), has been investigated in numerous studies, some of which have shown a tendency towards an improved outcome, whereas others have not been able to demonstrate any beneficial effect. A Cochrane report concluded that the majority of the trials that have already been published have been of low quality, with unclear allocation concealment. If only high-quality trials are considered, TBI patients treated with active cooling were more likely to die, a conclusion supported by a recent high-quality Canadian trial on children. Still, there is a belief that a modified protocol with a shorter time from the accident to the start of active cooling, longer cooling and rewarming time and better control of blood pressure and intracranial pressure would be beneficial for TBI patients. This belief has led to the instigation of new trials in adults and in children, including these types of protocol adjustments. The present review provides a short summary of our present knowledge of the use of active cooling in TBI patients, and presents some tentative explanations as to why active cooling has not been shown to be effective for outcome after TBI. We focus particularly on the compromised circulation of the penumbra zone, which may be further reduced by the stress caused by the difference in thermostat and body temperature and by the hypothermia-induced more frequent use of vasoconstrictors, and by the increased risk of contusional bleedings under hypothermia. We suggest that high fever should be reduced pharmacologically.

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“…[1,4,5]. Основным механизмом дей-ствия декомпрессии является создание дополни-тельного пространства для компенсации увеличен-ного внутричерепного объема [6][7][8]11]. Считается, что эффективность декомпрессии зависит от разме-ра декомпрессионного окна [9][10][11].…”

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Prх-monitoring based decision-making about decompressive craniectomy in a patient with severe traumatic brain injury. A case report

Ошоров

et al. 2015

Vopr. neirokhir.

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EBIC-Guidelines for management of severe head injury in adults

Cited by 528 publications

References 26 publications

Can We Optimize Long-Term Outcomes in Acute Respiratory Distress Syndrome by Targeting Normoxemia?

Can We Optimize Long-Term Outcomes in Acute Respiratory Distress Syndrome by Targeting Normoxemia?

Active cooling in traumatic brain‐injured patients: a questionable therapy?

Prх-monitoring based decision-making about decompressive craniectomy in a patient with severe traumatic brain injury. A case report

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