Secondary Insults and Adverse Events During Intrahospital Transport of Severe Traumatic Brain-Injured Patients

Martin, Mathieu; Cook, Fabrice; Lobo, David; Vermersch, C.; Attias, Arié; Mamar, Bouziane Ait; Plaud, Benoît; Mounier, R; Dhonneur, Gilles

doi:10.1007/s12028-016-0291-5

Cited by 32 publications

(36 citation statements)

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“…In their cohort of 31 patients, a significant risk for secondary insults and adverse events was demonstrated in IHT to perform computed tomography (CT) scan. However, all documented events may have resulted in a change in medical therapy, but did not significantly alter outcome (9). Similar findings have been reported by Kleffmann et al who observed a significant ICP increase during transport and CT scans (7).…”

Section: Discussionsupporting

confidence: 84%

“…Of these, six patients (13.0%) failed due to increased ICP, and therefore, no MRI was performed. Finally, 40 IHT for MRI were performed within the first 14 days after the trauma with a mean of 6 days (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. A single MRI examination was performed in 13 patients, two MRI scans in 12 patients, and three MRI examinations in one patient.…”

Section: Imagingmentioning

confidence: 99%

“…It is known that moving the patient from the NICU for therapeutic or diagnostic reasons is associated with numerous clinical issues such as increase in ICP, hemodynamic complications, or secondary insults (5)(6)(7)(8). Especially for head-injured patients, IHT-related adverse events can lead to secondary brain damage, making a selection of possible candidates necessary (5,9).…”

Section: Introductionmentioning

confidence: 99%

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Safety of Early MRI Examinations in Severe TBI: A Test Battery for Proper Patient Selection

et al. 2020

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Introduction: Early magnetic resonance imaging (MRI) provides important information for management and prognosis in patients with severe traumatic brain injury (sTBI). Yet, optimal timing of MRI remains unknown. The aim of our study was to evaluate the safety of early MRI and to identify a method for appropriate patient selection to minimize adverse events related to the intrahospital transport (IHT) and the MRI examination. Methods: Twenty-six patients with sTBI [mean Glasgow Coma Scale (GCS) 6, range 3-8] admitted to our neurosurgical ICU from 03/2015 to 12/2017 and receiving at least one MRI within the first 14 days after initial traumatic event were prospectively included in the study. The following requirements were fulfilled for at least 4 h prior to anticipated MRI: MAP > 70 mmHg, aPCO 2 30-40 mmHg, stable ICP < 25 mmHg. All relevant cardiopulmonary and cerebral parameters and medication were recorded. The following MRI sequences were performed: DWI, FLAIR, 3D T2-space, 3D T1 MPRAGE, 3D SWI, 3D TOF, pASL, and 1 H/ 31 P-MRS. Results: Four females and 22 males (aged 23-78 years, mean 46.4 years) with a median GCS on admission of 5 (range 3-8) were analyzed. In total, 40 IHTs were performed within the first 14 days (mean 6 days, range 1-14 days). Mean pre-MRI ICP was 14.1 mmHg (range 3-32 mmHg). The mean post-MRI ICP was 14.3 mmHg (range 3-29 mmHg), decreasing to a mean ICP of 13.2 mmHg after 1 h (range 3-29 mmHg). There were no significant differences in ICP measurements before and after MRI (p = 0.30). MAP remained stable with no significant changes during the entire IHT and MRI. No other adverse events were observed as well. Conclusion: Early MRI in acute severe TBI is feasible and safe. Yet, careful patient selection with prior adequate testing of cardiopulmonary and cerebral parameters is crucial to minimize transport-or examination-related morbidity.

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Section: Discussionsupporting

confidence: 84%

Section: Imagingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety of Early MRI Examinations in Severe TBI: A Test Battery for Proper Patient Selection

et al. 2020

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“…Esses achados estão de acordo com estudos que apontam que os indivíduos do sexo masculino, em faixa produtiva, sofrem alterações locais e sistêmicas em decorrência do trauma. Nos casos mais graves, as lesões são mais complexas e a intervenção cirúrgica é necessária para diminuir a pressão intracraniana, reduzir o espaço ocupado pela lesão e melhorar a sobrevida dos pacientes (6)(7) .…”

Section: Variáveis N (%)unclassified

Incidentes e eventos adversos no transporte intra-hospitalar em terapia intensiva

Silva

Amante

Salum

et al. 2018

R. Enferm. Cent. O. Min.

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Objetivo: identificar os incidentes e eventos adversos no transporte intra-hospitalar em terapia intensiva. M�todo: estudo descritivo, prospectivo, quantitativo, cuja coleta de dados ocorreu com 103 transportes e envolvendo 100 profissionais de sa�de que atuavam em uma unidade de terapia intensiva de um hospital p�blico. Os dados foram obtidos por meio de um roteiro de observa��o e analisados descritivamente. Resultados: a maioria dos incidentes encontrados foi com equipamentos e os eventos adversos observados foram relativos �s altera��es fisiol�gicas. Conclus�o: o transporte intra-hospitalar � considerado um procedimento de risco para o paciente, cujas complica��es podem ser minimizadas com a elabora��o de protocolos institucionais e de capacita��es da equipe para realiza��o de um transporte seguro.

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“…When a patient presents with TBI, the initial assessment requires high spatial resolution imaging to understand affected neuroanatomy. Anatomical imaging should continue to be employed judiciously to avoid secondary insults (3). Once obtained and initial interventions are performed, techniques with high temporal resolution can be employed for long-term continuous monitoring to understand ensuing physiology.…”

Section: Introductionmentioning

confidence: 99%

Approaches to Multimodality Monitoring in Pediatric Traumatic Brain Injury

et al. 2019

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Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Improved methods of monitoring real-time cerebral physiology are needed to better understand when secondary brain injury develops and what treatment strategies may alleviate or prevent such injury. In this review, we discuss emerging technologies that exist to better understand intracranial pressure (ICP), cerebral blood flow, metabolism, oxygenation and electrical activity. We also discuss approaches to integrating these data as part of a multimodality monitoring strategy to improve patient care.

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Secondary Insults and Adverse Events During Intrahospital Transport of Severe Traumatic Brain-Injured Patients

Abstract: IHT carries significant SIs and AEs in severe TBI patients. To improve a risk/benefit ratio favorable for patients, a program focusing on IHT complications regarding therapeutic impact of control CT scan is needed.

Cited by 32 publications

References 20 publications

Safety of Early MRI Examinations in Severe TBI: A Test Battery for Proper Patient Selection

Safety of Early MRI Examinations in Severe TBI: A Test Battery for Proper Patient Selection

Incidentes e eventos adversos no transporte intra-hospitalar em terapia intensiva

Approaches to Multimodality Monitoring in Pediatric Traumatic Brain Injury

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