Prevention of Secondary Insults in Neurointensive Care of Traumatic Brain Injury

2003 ◽  
Vol 29 (2) ◽  
pp. 74-80 ◽  
Author(s):  
Per Enblad ◽  
Kristin Elf ◽  
Pelle Nilsson
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Neurointensive Care ◽  
Secondary Insults

scholarly journals Neurointensive care of traumatic brain injury in the elderly—age-specific secondary insult levels and optimal physiological levels to target need to be defined

2021 ◽  
Author(s):  
Samuel Lenell ◽  
Anders Lewén ◽  
Timothy Howells ◽  
Per Enblad
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
The Elderly ◽  
Favorable Outcome ◽  
Neurointensive Care ◽  
Younger Patients ◽  
Secondary Insults ◽  
Secondary Insult ◽  
Monitoring Time ◽  
The Impact

Abstract Background Elderly patients with traumatic brain injury increase. Current targets and secondary insult definitions during neurointensive care (NIC) are mostly based on younger patients. The aim was therefore to study the occurrence of predefined secondary insults and the impact on outcome in different ages with particular focus on elderly. Methods Patients admitted to Uppsala 2008–2014 were included. Patient characteristics, NIC management, monitoring data, and outcome were analyzed. The percentage of monitoring time for ICP, CPP, MAP, and SBP above-/below-predefined thresholds was calculated. Results Five hundred seventy patients were included, 151 elderly ≥ 65 years and 419 younger 16–64 years. Age ≥ 65 had significantly higher percentage of CPP > 100, MAP > 120, and SBP > 180 and age 16–64 had higher percentage of ICP ≥ 20, CPP ≤ 60, and MAP ≤ 80. Age ≥ 65 contributed independently to the different secondary insult patterens. When patients in all ages were analyzed, low percentage of CPP > 100 and SBP > 180, respectively, was significant predictors of favorable outcome and high percentage of ICP ≥ 20, CPP > 100, SBP ≤ 100, and SBP > 180, respectively, was predictors of death. Analysis of age interaction showed that patients ≥ 65 differed and had a higher odds for favorable outcome with large proportion of good monitoring time with SBP > 180. Conclusions Elderly ≥ 65 have different patterns of secondary insults/physiological variables, which is independently associated to age. The finding that SBP > 180 increased the odds of favorable outcome in the elderly but decreased the odds in younger patients may indicate that blood pressure should be treated differently depending on age.

scholarly journals Fine Tuning of Traumatic Brain Injury Management in Neurointensive Care—Indicative Observations and Future Perspectives

2021 ◽  
Vol 12 ◽  
Author(s):  
Teodor M. Svedung Wettervik ◽  
Anders Lewén ◽  
Per Enblad
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Fine Tuning ◽  
Neurointensive Care ◽  
Secondary Brain Injury ◽  
Brain Tissue Oxygenation ◽  
Treatment Protocols ◽  
Injury Mechanisms ◽  
Severe Tbi ◽  
Type Of Injury

Neurointensive care (NIC) has contributed to great improvements in clinical outcomes for patients with severe traumatic brain injury (TBI) by preventing, detecting, and treating secondary insults and thereby reducing secondary brain injury. Traditional NIC management has mainly focused on generally applicable escalated treatment protocols to avoid high intracranial pressure (ICP) and to keep the cerebral perfusion pressure (CPP) at sufficiently high levels. However, TBI is a very heterogeneous disease regarding the type of injury, age, comorbidity, secondary injury mechanisms, etc. In recent years, the introduction of multimodality monitoring, including, e.g., pressure autoregulation, brain tissue oxygenation, and cerebral energy metabolism, in addition to ICP and CPP, has increased the understanding of the complex pathophysiology and the physiological effects of treatments in this condition. In this article, we will present some potential future approaches for more individualized patient management and fine-tuning of NIC, taking advantage of multimodal monitoring to further improve outcome after severe TBI.

scholarly journals Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care

2019 ◽  
Vol 161 (6) ◽  
pp. 1243-1254 ◽  
Author(s):  
Samuel Lenell ◽  
Lena Nyholm ◽  
Anders Lewén ◽  
Per Enblad
Keyword(s):  
Traumatic Brain Injury ◽  
Prognostic Factors ◽  
Brain Injury ◽  
Clinical Outcome ◽  
Neurointensive Care

Temperature disturbances in traumatic brain injury: relationship to secondary insults, barbiturate treatment and outcome

2008 ◽  
Vol 30 (10) ◽  
pp. 1097-1105 ◽  
Author(s):  
Kristin Elf ◽  
Pelle Nilsson ◽  
Elisabeth Ronne-Engström ◽  
Tim Howells ◽  
Per Enblad
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Secondary Insults

scholarly journals Reducing Secondary Insults in Traumatic Brain Injury

2015 ◽  
Vol 180 (3S) ◽  
pp. 50-55 ◽  
Author(s):  
Jay A. Johannigman ◽  
David Zonies ◽  
Joseph Dubose ◽  
Thomas C. Blakeman ◽  
Dennis Hanseman ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Secondary Insults

scholarly journals Trajectories of early secondary insults correlate to outcomes of traumatic brain injury: results from a large, single centre, observational study

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Paola Cristina Volpi ◽  
Chiara Robba ◽  
Matteo Rota ◽  
Alessia Vargiolu ◽  
Giuseppe Citerio
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Observational Study ◽  
Single Centre ◽  
Secondary Insults
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