2002
DOI: 10.1590/s0004-282x2002000400031
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Practical and comprehensive guidelines for bedside cerebral hemometabolic multitherapeutic optimization

Abstract: -In recent years, noncomprehensive "guidelines" were proposed for the management of severe acute brain injuries, focusing strictly on two approaches: 1) to maintain cerebral perfusion pressure anywhere above 70 mm Hg; and 2) to maintain arterial carbon dioxide tension levels above 30 torr. Strictly following these propositions, a recently reported prospective controlled study addressed mortality rates of no less than 75-76%, far worse than mortality rates reported before those "guidelines" were published. As a… Show more

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Cited by 3 publications
(5 citation statements)
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“…When nonsurgical management fails to control ICP and cerebral herniation, decompressive craniectomy may be indicated as a last resort. 4,7,13 Despite many publications on the subject, 2,6,9,12,14,17,24,34,36,39,43,44,49,52,55 the actual benefit of this treatment modality on neurological outcome in patients remains unknown. The hemodynamic changes in the brain in response to decompressive craniectomy have not been systematically studied in patients with traumatic brain swelling.…”
Section: Discussionmentioning
confidence: 99%
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“…When nonsurgical management fails to control ICP and cerebral herniation, decompressive craniectomy may be indicated as a last resort. 4,7,13 Despite many publications on the subject, 2,6,9,12,14,17,24,34,36,39,43,44,49,52,55 the actual benefit of this treatment modality on neurological outcome in patients remains unknown. The hemodynamic changes in the brain in response to decompressive craniectomy have not been systematically studied in patients with traumatic brain swelling.…”
Section: Discussionmentioning
confidence: 99%
“…Therefore, performing decompressive craniectomy as the sole treatment is insufficient. Even during postoperative phases, all efforts must be made to maintain adequate brain hemodynamics, 32,46 preferably coupled with brain metabolism 7,8 as well as to promoting pharmacological brain protection and regeneration so that some degree of brain recovery can be possible. For the future, we hope that routine TCD monitoring of both cerebral autoregulation and cerebral vasomotor reactivity may help in offering adequate intracranial hemodynamics, and consequently, adequate CBF to brain-injured patients.…”
Section: Discussionmentioning
confidence: 99%
“…Based on our data, we can observe mean intracranial pressures greater than 20 mmHg during the clinical outcome of adult and pediatric patients ( Table 3 and 4). Mean ICP in children was higher on the first days following TBI, dropping thereafter.…”
Section: Discussionmentioning
confidence: 63%
“…Adelson et al suggest that a CPP of 50-65 mmHg is appropriate for the pediatric group and that a CPP less than 40 mmHg is consistently associated with an increase in mortality 2 . In the pediatric group, mean CPP was 40 mmHg and mean ICP amounted to 32 mmHg, whereas in adults, mean CPP was 52 mmHg and mean ICP was 31 mmHg (Table 3 and 4). Although the pediatric group had a slightly higher mean ICP and a lower mean CPP, mortality was higher among adult patients.…”
Section: Discussionmentioning
confidence: 91%
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