Surgical Management of Traumatic Parenchymal Lesions

Bullock, M. Ross; Chesnut, Randall M.; Ghajar, Jamshid; Gordon, David S.; Härtl, Roger; Newell, David W.; Servadei, Franco; Walters, Beverly C.; Wilberger, Jack E.

doi:10.1227/01.neu.0000210365.36914.e3

Cited by 212 publications

(162 citation statements)

References 55 publications

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“…It is strongly recommended in patients with complications from the other therapies. The results could be better if applied earlier in the course of intracranial hypertension [139].…”

Section: Box 2 Management Of the Traumatic Brain Injury Patientmentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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“…It is strongly recommended in patients with complications from the other therapies. The results could be better if applied earlier in the course of intracranial hypertension [139].…”

Section: Box 2 Management Of the Traumatic Brain Injury Patientmentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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“…(Bullock et al, 2006) Hyperosmolar agents currently in clinical use for TBI are mannitol and hypertonic saline. Mannitol is widely used and its use is advocated in two circumstances.…”

Section: Conservative Treatment Of Intracranial Hypertensionmentioning

confidence: 99%

“…Second, mannitol has been used as a prolonged therapy for raised ICP. (Bullock et al , 2006). There is a level II evidence that mannitol is effective for control of raised intracranial pressure (ICP) at doses of 0.25 gm/kg to 1 g/kg body weight.…”

Section: Conservative Treatment Of Intracranial Hypertensionmentioning

confidence: 99%

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Decompressive Craniectomy for Refractory Intracranial Hypertension

Bar¹,

Reguli²,

Lipina³

2012

Explicative Cases of Controversial Issues in Neurosurgery

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“…15 Patients with GCS scores of 6 to 8 with frontal or temporal contusions greater than 20 cc in volume with midline shift of at least 5 mm and/or cisternal compression on CT scan, and patients with any lesion greater than 50 cc in volume should also be treated operatively.…”

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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Surgical Management of Traumatic Parenchymal Lesions

Cited by 212 publications

References 55 publications

Critical Care Issues in the Early Management of Severe Trauma

Critical Care Issues in the Early Management of Severe Trauma

Decompressive Craniectomy for Refractory Intracranial Hypertension

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

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