The Role of Secondary Brain Injury in Determining Outcome From Severe Head Injury

Chesnut, Randall M.; Marshall, Lawrence F.; Klauber, Melville R.; Blunt, Barbara A.; Baldwin, Nevan G.; Eisenberg, Howard M.; Jane, John A.; Marmarou, Anthony; Foulkes, Mary A.

doi:10.1097/00005373-199302000-00006

Cited by 1,901 publications

(957 citation statements)

References 0 publications

Supporting

Mentioning

879

Contrasting

Unclassified

Order By: Relevance

“…Nonneurological organ dysfunction is an important predictor 66 Early physiological derangements are known to be associated with worse outcomes, and their timely correction could influence recovery. [67][68][69] Consistent with this notion, one randomized controlled trial demonstrated that pre-hospital rapid sequence intubation (RSI) by paramedics increased the proportion of TBI patients with a favourable neurological recovery. 14 Pre-hospital RSI was routine practice in Southern Alberta even before the time period assessed in this study.…”

Section: Discussionmentioning

confidence: 93%

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Kramer

Zygun

2013

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 93%

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Kramer

Zygun

2013

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

“…A prospective study of 717 TBI patients has shown 50% mortality in those with systolic blood pressure (SBP) less than 90 mmHg and 57% mortality in patients with both hypotension and hypoxia with a PaO 2 less than 60 mmHg, compared with 27% mortality in patients without any hypotension and hypoxia. 55 A mortality of 83% was observed in TBI patients with a SBP below 90 mmHg within 24 h of admission, compared with 45% in patients with SBP above 90 mmHg. 56 In a study of 107 patients, a linear correlation was observed between the number of hypotensive episodes with SBP below 90 mmHg and mortality during initial resuscitation.…”

Section: Efficacy Studies With Magnesiummentioning

confidence: 98%

Use of Magnesium in Traumatic Brain Injury

Sen¹,

Gulati

2010

Neurotherapeutics

View full text Add to dashboard Cite

Summary: Depletion of magnesium is observed in animal brain and in human blood after brain injury. Treatment with magnesium attenuates the pathological and behavioral changes in rats with brain injury; however, the therapeutic effect of magnesium has not been consistently observed in humans with traumatic brain injury (TBI). Secondary brain insults are observed in patients with brain injury, which adversely affect clinical outcome. Systemic administration studies in rats have shown that magnesium enters the brain; however, inducing hypermagnesemia in humans did not concomitantly increase magnesium levels in the CSF. We hypothesize that the neuroprotective effects of magnesium in TBI patients could be observed by increasing its brain bioavailability with mannitol. Here, we review the role of magnesium in brain injury, preclinical studies in brain injury, clinical safety and efficacy studies in TBI patients, brain bioavailability studies in rat, and pharmacokinetic studies in humans with brain injury. Neurodegeneration after brain injury involves multiple biochemical pathways. Treatment with a single agent has often resulted in poor efficacy at a safe dose or toxicity at a therapeutic dose. A successful neuroprotective therapy needs to be aimed at homeostatic control of these pathways with multiple agents. Other pharmacological agents, such as dexanabinol and progesterone, and physiological interventions, with hypothermia and hyperoxia, have been studied for the treatment of brain injury. Treatment with magnesium and hypothermia has shown favorable outcome in rats with cerebral ischemia. We conclude that coadministration of magnesium and mannitol with pharmacological and physiological agents could be an effective neuroprotective regimen for the treatment of TBI.

show abstract

“…Secondary insults, representing discrete events that may be monitored for and intervened upon, are predictable, potentially avoidable, and include systemic causes such as hypotension [93,94], hypocarbia, hypercarbia [78,79,95], hypoxia [11,96], hyperthermia [97], and hyperglycemia [98,99]. These insults result in secondary injuries which signify underlying neurological processes related to cellular and molecular mechanisms of injury/ death, including inflammatory responses, impairment of cerebral autoregulation, excitotoxicity, delayed cell death, and BBB breakdown [92].…”

Section: Secondary Insults and Injuriesmentioning

confidence: 99%

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Udomphorn

Armstead

Vavilala

2008

Pediatric Neurology

133

View full text Add to dashboard Cite

Traumatic brain injury is a global health concern and is the leading cause of traumatic morbidity and mortality in children. Despite a lower overall mortality than in adult traumatic brain injury, the cost to society from the sequelae of pediatric traumatic brain injury is very high. Predictors of poor outcome after traumatic brain injury include altered systemic and cerebral physiology, including altered cerebral hemodynamics. Cerebral autoregulation is often impaired following traumatic brain injury and may adversely impact poor outcome. Although altered cerebrovascular hemodynamics early after traumatic brain injury may contribute to disability in children, there is a paucity of information regarding changes in cerebral blood flow and cerebral autoregulation after pediatric traumatic brain injury. In this article, we discuss normal pediatric cerebral physiology and cerebrovascular pathophysiology following pediatric traumatic brain injury.

show abstract

The Role of Secondary Brain Injury in Determining Outcome From Severe Head Injury

Cited by 1,901 publications

References 0 publications

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Use of Magnesium in Traumatic Brain Injury

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Contact Info

Product

Resources

About