Hypothermia for Intracranial Hypertension after Traumatic Brain Injury

O’Leary, Rebecca A.; Hutchinson, Peter J.; Menon, David

doi:10.1056/nejmoa1507581

Cited by 490 publications

(320 citation statements)

References 37 publications

(30 reference statements)

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“…These studies have contributed to complicated adherence to the BTF guidelines on hyperthermia. [21][22][23] Although infection prophylaxis to reduce pneumonia is recommended for patients when tracheostomies are created, we found no strong adherence to such prophylaxis. The low incidence of pneumonia might be attributed to use of other periprocedural or continuous antibiotics.…”

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confidence: 71%

“…8 We suspect this reported improvement is the reason approximately 11% of patients in our study received the intervention. Although evidence supports the use of early prophylactic mild-to-moderate hypothermia in patients with severe TBI (GCS score < 7) to decrease mortality and improve neurological recovery, 21,22 recent findings 23 indicate no better outcomes in TBI patients when hypothermia is used along with standard care. These studies have contributed to complicated adherence to the BTF guidelines on hyperthermia.…”

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confidence: 99%

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Increasing Adherence to Brain Trauma Foundation Guidelines for Hospital Care of Patients With Traumatic Brain Injury

Saherwala

Bader

Stutzman

et al. 2018

Critical Care Nurse

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Background The Brain Trauma Foundation has developed treatment guidelines for the care of patients with acute traumatic brain injury. The Adam Williams Initiative is a program established to provide education and resources to encourage hospitals across the United States to incorporate the guidelines into practice. Objective To explore the relationship in hospitals between participation in the Adam Williams Initiative and adherence to the Brain Trauma Foundation guidelines for patients with acute traumatic brain injury. Method Hospitals that participated in the Adam Williams Initiative entered data into an online tracking system of patients with traumatic brain injury for at least 2 years after the initial site training. Data included baseline hospital records and daily records on hospital care of patients with traumatic brain injury, including blood pressure, intracranial pressure, cerebral perfusion pressure, oxygenation, and other data relevant to the 15 key metrics in the Brain Trauma Foundation guidelines. Results The 16 hospitals funded by the Adam Williams Initiative had good overall adherence to the 15 key metrics of the recommendations detailed in the Brain Trauma Foundation guidelines. Variability in results was primarily due to data collection methods and analysis. Conclusions The Adam Williams Initiative helps promote adherence to the Brain Trauma Foundation guidelines for hospital care of patients with traumatic brain injury by providing a platform for developing and standardizing best practices. Participation in the initiative is associated with high adherence to clinical guidelines, a situation that may subsequently improve care and outcomes for patients with traumatic brain injury. (Critical Care Nurse. 2018;38[1]:e11-e20)

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confidence: 71%

mentioning

confidence: 99%

Increasing Adherence to Brain Trauma Foundation Guidelines for Hospital Care of Patients With Traumatic Brain Injury

Saherwala

Bader

Stutzman

et al. 2018

Critical Care Nurse

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“…11 Our obsession to overnormalize and to overthink the homeostasis of critically ill patients with severe traumatic brain injury may lead us to use interventions that are not based on evidence and may even cause harm. 12 This study by Griesdale et al highlights the current lack of evidence surrounding the use of hypertonic saline infusion to sustain higher serum sodium levels in critically ill patients with severe traumatic brain injury. It does not support the use of hypertonic saline infusion in the management of critically ill patients with traumatic brain injury or the implementation of strict serum sodium targets.…”

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confidence: 95%

“…11 Notre obsession de surnormalisation et de surestimation de l'homéostasie chez les patients en état critique à la suite d'un traumatisme crâniocérébral grave peut nous conduire à utiliser des interventions qui ne sont pas basées sur des données probantes et qui pourraient même être nocives. 12 Cette étude de Griesdale et coll. souligne l'absence actuelle de données probantes entourant l'utilisation de perfusions de solution salée hypertonique pour le maintien de taux élevés de sodium sérique chez des patients en état critique avec traumatisme crâniocérébral grave.…”

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Managing critically ill patients with severe traumatic brain injury: How should we season the recipe?

Bonaventure

Lauzier

Turgeon

2016

Can J Anesth/J Can Anesth

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Maintaining adequate cerebral perfusion remains the overarching objective in the management of critically ill patients with severe traumatic brain injury. Despite limited evidence, the concept of maintaining normal intracranial pressure has been the driving force behind most interventions over the last few decades. The current guidelines for the management of severe traumatic brain injury advocate limiting brain edema using hyperosmolar therapy with mannitol to control elevated intracranial pressure.1 Nevertheless, concerns that the diuretic effect of mannitol induces hypovolemia have led to the popularity of using hypertonic saline solutions as an alternative optionthis despite limited evidence.2,3 Moreover, concerns that hyponatremia may lead to increased cerebral edema have led to a broader use of hypertonic saline as a continuous infusion with the goal of either normalizing or obtaining a greater than normal serum sodium. 4 In this issue of the Journal, Griesdale et al. publish the results of a retrospective cohort study (two centres, n = 231 patients) that aimed to evaluate the effect of a continuous 3% hypertonic saline infusion on the incidence of hypernatremia and mortality in patients with severe traumatic brain injury.5 This study provides new insights into this important topic in neurocritical care with findings that are not in agreement with the previous literature. The authors considered many relevant confounders in the adjusted analyses, including markers of trauma severity (abnormal pupillary reactivity, hypotension upon admission, and use of mannitol) and diabetes insipidus (use of desmopressin). Moreover, the multivariable stratified Cox regression analysis allowed consideration of the effect of time-since hypertonic saline solutions and hypernatremia were modelled as time-dependent variables. The investigators found no association between hospital mortality and continuous hypertonic saline infusion (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.56 to 2.05; P = 0.84) or hypernatremia (HR, 1.31; 95% CI, 0.68 to 2.55; P = 0.42). Additionally, they observed that hypertonic saline did not modify the relationship between hypernatremia and death-i.e., among patients who received hypertonic saline, the occurrence of hypernatremia was not associated with increased mortality (HR, 1.52; 95% CI, 0.16 to 14.7; P = 0.79). Due to the nature of the intervention and the study design, the presence of residual confounding cannot be excluded, and the authors did not account for several other cointerventions. For example, patients who received hypertonic saline infusion seemed to have experienced a decrease in intracranial pressure, but other co-interventions that may impact on the control of intracranial pressure, such as sedatives, neuromuscular blockade, and therapeutic hypothermia (or controlled normothermia), were not measured. Also, the analysis of the impact of hypertonic saline infusion on the control of intracranial pressure was

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“…17, 18 In addition to MIH, prophylactic hyperventilation can be delivered to patient with TBI. Hyperventilation lowers intracranial pressure (ICP) by the induction of cerebral vasoconstriction with a subsequent decrease in cerebral blood volume.…”

mentioning

confidence: 99%

Efficacy Comparison of Mannitol and Hypertonic Saline for Traumatic Brain Injury (TBI) Treatment

Arifianto¹,

Ma'ruf²,

Ibrahim³

2016

Bali Med J.

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Traumatic Brain Injury (TBI) case is commonly found in the emergency room. TBI accompanied by increased intracranial pressure (ICP) is a neurological emergency that requires prompt and appropriate management. Hyperosmolar fluid is the main treatment in the initial management of increased ICP. Mannitol and hypertonic saline are hyperosmolar fluids which are generally used. There is no specific recommendation regarding the choice between the two fluids. From the current studies indicate that both fluids are equally effective in reducing ICP. Regarding the superiority between the two fluids, it is difficult to determine because of the heterogeneity of the studies that exist. Therefore, clinicians should choose between hyperosmolar fluids based on indications and contraindications exist in TBI patients.

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Hypothermia for Intracranial Hypertension after Traumatic Brain Injury

Cited by 490 publications

References 37 publications

Increasing Adherence to Brain Trauma Foundation Guidelines for Hospital Care of Patients With Traumatic Brain Injury

Increasing Adherence to Brain Trauma Foundation Guidelines for Hospital Care of Patients With Traumatic Brain Injury

Managing critically ill patients with severe traumatic brain injury: How should we season the recipe?

Efficacy Comparison of Mannitol and Hypertonic Saline for Traumatic Brain Injury (TBI) Treatment

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