Management of Medical Complications During the Rehabilitation of Moderate-Severe Traumatic Brain Injury

Schultz, Billie A.; Bellamkonda, Erica

doi:10.1016/j.pmr.2016.12.004

Cited by 8 publications

(9 citation statements)

References 68 publications

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“…A sustained ICP > 20 -25 mmHg is considered pathologically significant due to the high correlation between an elevated ICP and mortality [19]. Recent studies have reported that IVH, SAH, age, DC, GCS score, Fisher score, and CSF infection could be risk factors for PTH development [18,20]. These previous findings represented the observational data for our study.…”

supporting

confidence: 52%

“…Despite advances in first aid capability and intensive care management, the reported mortality rates for severe TBI remain high (27%–46%) [ 15 – 17 ]. PTH can develop either in the acute or recovery stage of TBI at a reported rate of 0.7%–51.4% [ 18 ], and it often affects the outcome, rehabilitation, and quality of life of patients with TBI. ICP elevation is a significant cause of death and long-term disability resulting from head injuries and other intracranial pathological conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Despite advances in first aid capability and intensive care management, the reported mortality rates for severe TBI remain high (27%-46%) [15][16][17]. PTH can develop either in the acute or recovery stage of TBI at a reported rate of 0.7%-51.4% [18], and it often affects the outcome, rehabilitation, and quality of life of patients with TBI. ICP elevation is a significant cause of death and long-term disability resulting Figure 1: Comparison of the ICP: (a) there is no significant difference in the mean ICP before or during the weaning trial (p = 0:780 and p = 0:078, t-test); (b) the delta ICP is greater in the unfavorable outcome group (p = 0:001, t-test); (c) AUC for ICP > 20 mmHg is significantly different between the favorable outcome group and patients who died and developed PTH (p = 0:016, Mann-Whitney U test); (d) ROC analyses showing that the delta ICP has an AUC = 0:818 and p = 0:002, while the AUC for ICP > 20 mmHg has an AUC = 0:758 and p = 0:038.…”

Section: Biomed Research Internationalmentioning

confidence: 99%

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Intracranial Pressure during External Ventricular Drainage Weaning Is an Outcome Predictor of Traumatic Brain Injury

Chen

et al. 2020

BioMed Research International

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External ventricular drainage (EVD) is widely used in patients with a traumatic brain injury (TBI). However, the EVD weaning trial protocol varies and insufficient studies focus on the intracranial pressure (ICP) during the weaning trial. We aimed to establish the relationship between ICP during an EVD weaning trial and the outcomes of TBI. We enrolled 37 patients with a TBI with an EVD from July 2018 to September 2019. Among them, 26 were allocated to the favorable outcome group and 11 to the unfavorable outcome group (death, post-traumatic hydrocephalus, persistent vegetative state, and severe disability). Groups were well matched for sex, pupil reactivity, admission Glasgow Coma Scale score, Marshall computed tomography score, modified Fisher score, intraventricular hemorrhage, EVD days, cerebrospinal fluid output before the weaning trial, and the complications. Before and during the weaning trial, we recorded the ICP at 1-hour intervals to calculate the mean ICP, delta ICP, and ICP burden, which was defined as the area under the ICP curve. There were significant between-group differences in the age, surgery types, and intensive care unit days (p=0.045, p=0.028, and p=0.004, respectively). During the weaning trial, 28 (75.7%) patients had an increased ICP. Although there was no significant difference in the mean ICP before and during the weaning trial, the delta ICP was higher in the unfavorable outcome group (p=0.001). Moreover, patients who experienced death and hydrocephalus had a higher ICP burden, which was above 20 mmHg (p=0.016). Receiver operating characteristic analyses demonstrated the predictive ability of these variables (area under the curve AUC=0.818 [p=0.002] for delta ICP and AUC=0.758 [p=0.038] for ICP burden>20 mmHg). ICP elevation is common during EVD weaning trials in patients with TBI. ICP-related parameters, including delta ICP and ICP burden, are significant outcome predictors. There is a need for larger prospective studies to further explore the relationship between ICP during EVD weaning trials and TBI outcomes.

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confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Biomed Research Internationalmentioning

confidence: 99%

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Intracranial Pressure during External Ventricular Drainage Weaning Is an Outcome Predictor of Traumatic Brain Injury

Chen

et al. 2020

BioMed Research International

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“…Les lésions cérébrales touchent également les réseaux moteurs entrainant des troubles de la régulation tonique et du contrôle moteur volontaire (Barat & Mazaux, 1986;Schultz & Bellamkonda, 2017;Weimar, Ziegler, König, 2002). La motricité volontaire comme outil de la connaissance de soi, subit des limitations.…”

Section: L'altération De La Perception Du Corps Vivantunclassified

L’impropréité du corps vivant. De l’énaction capacitaire à son émersion vécue

Agostinucci

Liné

Lachal³

et al. 2019

intel

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De nombreux courants de l'écologique questionnent les rapports entre le corps et son environnement. Il convient aujourd'hui de mettre en exergue leur complémentarité. A travers l'analyse de l'émersion des sensibles du vivant dans la conscience du corps vécu, l'émersiologie est mise en perspective des travaux de Varela sur l'énaction. L'émersion et l'impropréité y sont définies et illustrées par des vignettes cliniques issues de la neurologie et de la psychiatrie. Enfin le passage des différentes étapes de l'énaction et de l'émersion sont abordées en complémentarité dans la compréhension d'un phénomène global.

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“…Motor, cognitive, behavioural and personality deficits, which may occur following TBI, can be disabling. Some potential common complications, especially after moderate-severe TBI include posttraumatic seizures (PTS) and epilepsy, hydrocephalus, paroxysmal sympathetic hyperactivity, spasticity, agitation, neuroendocrine dysfunction, heterotrophic ossification, venous thromboembolism, sleep disturbances and cranial nerve dysfunction [ 5 , 7 – 10 ]. The reported incidence of posttraumatic seizures and epilepsy vary between 4–53% [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Overview of systematic reviews: Management of common Traumatic Brain Injury-related complications

2022

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Background Many clinical interventions are trialled to manage medical complications following Traumatic Brain Injury (TBI). However, published evidence for the effects of those clinical interventions is limited. This article is an overview of common complications and their management from published systematic reviews in TBI. Methods and findings A health science electronic database search for published systematic reviews for management of common complications in TBI was conducted in the last decade till 31st January 2021. Methodological quality and evidence were critically appraised using the Grading of Recommendations, Assessment, Development and Evaluations and Revised-Assessment of Multiple Systematic review tools. Overall, only six systematic reviews complied with search criteria, these evaluated fatigue, spasticity and post traumatic seizures (29 RCTs, 13 cohort studies, n = 5639 participants). No systematic reviews for other common TBI-related complications met criteria for this review. The included reviews varied from ‘moderate to high’ in methodological quality. The findings suggest beneficial treatment effect of anti-epileptic drugs (phenytoin/levetiracetam) compared with placebo in reducing early seizure incidence, but no significant benefit of phenytoin over levetiracetam, valproate, or neuroprotective agent for early or late posttraumatic seizures. There was ‘limited’ evidence for spasticity-related interventions, and ‘insufficient’ evidence of cardiorespiratory training on fatigue levels. Conclusions Despite the high prevalence and associated functional impact of TBI-related complications, there is limited evidence to guide treating clinicians for management of common TBI complications. More robust studies are needed to build evidence in this population.

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Management of Medical Complications During the Rehabilitation of Moderate-Severe Traumatic Brain Injury

Cited by 8 publications

References 68 publications

Intracranial Pressure during External Ventricular Drainage Weaning Is an Outcome Predictor of Traumatic Brain Injury

Intracranial Pressure during External Ventricular Drainage Weaning Is an Outcome Predictor of Traumatic Brain Injury

L’impropréité du corps vivant. De l’énaction capacitaire à son émersion vécue

Overview of systematic reviews: Management of common Traumatic Brain Injury-related complications

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