Changes in Therapeutic Intensity Level Following Airway Pressure Release Ventilation in Severe Traumatic Brain Injury

2016 ◽  
Vol 33 (3) ◽  
pp. 196-202 ◽  
Author(s):  
Jeffrey J. Fletcher ◽  
Thomas J. Wilson ◽  
Venkatakrishna Rajajee ◽  
Scott B. Davidson ◽  
Jon C. Walsh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Airway Pressure ◽  
Intensity Level ◽  
Static Compliance ◽  
Pressure Release ◽  
Therapeutic Intensity ◽  
Pressure Release Ventilation ◽  
Over Time

Purpose: Airway pressure release ventilation (APRV) utilizes high levels of airway pressure coupled with brief expiratory release to facilitate open lung ventilation. The aim of our study was to evaluate the effects of APRV-induced elevated airway pressure mean in patients with severe traumatic brain injury. Materials and Methods: This was a retrospective cohort study at a 424-bed Level I trauma center. Linear mixed effects models were developed to assess the difference in therapeutic intensity level (TIL), intracranial pressure (ICP), and cerebral perfusion pressure (CPP) over time following the application of APRV. Results: The study included 21 epochs of APRV in 21 patients. In the 6-hour epoch following the application of APRV, the TIL was significantly increased ( P = .002) and the ICP significantly decreased ( P = .041) compared to that before 6 hours. There was no significant change in CPP ( P = .42) over time. The baseline static compliance and time interaction was not significant for TIL (χ2 = 0.2 [ df 1], P = .655), CPP (χ2 = 0 [ df 1], P = 1), or ICP (χ2 = 0.1 [ df 1], P = .752). Conclusions: Application of APRV in patients with severe traumatic brain injury was associated with significantly, but not clinically meaningful, increased TIL and decreased ICP. No significant change in CPP was observed. No difference was observed based on the baseline pulmonary static compliance.

scholarly journals Decompressive Craniectomy for Elevated Intracranial Pressure and Its Effect on the Cumulative Ischemic Burden and Therapeutic Intensity Levels After Severe Traumatic Brain Injury

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1111-1119 ◽  
Author(s):  
Gregory M. Weiner ◽  
Michelle R. Lacey ◽  
Larami Mackenzie ◽  
Darshak P. Shah ◽  
Suzanne G. Frangos ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Intensity Level ◽  
Before And After ◽  
Severe Tbi ◽  
Therapeutic Intensity ◽  
The Brain

Abstract BACKGROUND Increased intracranial pressure (ICP) can cause brain ischemia and compromised brain oxygen (PbtO2 ≤ 20 mm Hg) after severe traumatic brain injury (TBI). OBJECTIVE We examined whether decompressive craniectomy (DC) to treat elevated ICP reduces the cumulative ischemic burden (CIB) of the brain and therapeutic intensity level (TIL). METHODS Ten severe TBI patients (mean age, 31.4 ± 14.2 years) who had continuous PbtO2 monitoring before and after delayed DC were retrospectively identified. Patients were managed according to the guidelines for the management of severe TBI. The CIB was measured as the total time spent between a PbtO2 of 15 to 20, 10 to 15, and 0 to 10 mm Hg. The TIL was calculated every 12 hours. Mixed-effects models were used to estimate changes associated with DC. RESULTS DC was performed on average 2.8 days after admission. DC was found to immediately reduce ICP (mean [SEM] decrease was 7.86 mm Hg [2.4 mm Hg]; P = .005). TIL, which was positively correlated with ICP (r = 0.46, P ≤ .001), was reduced within 12 hours after surgery and continued to improve within the postsurgical monitoring period (P ≤ .001). The duration and severity of CIB were significantly reduced as an effect of DC in this group. The overall mortality rate in the group of 10 patients was lower than predicted at the time of admission (P = .015). CONCLUSION These results suggest that a DC for increased ICP can reduce the CIB of the brain after severe TBI. We suggest that DC be considered early in a patient's clinical course, particularly when the TIL and ICP are increased.

CHANGES IN THE OUTCOME OF PEDIATRIC PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY OVER TIME

2004 ◽  
Vol 32 (Supplement) ◽  
pp. A101
Author(s):  
Kelly S Tieves ◽  
Cheryl A Muszynski ◽  
Bruce A Kaufman ◽  
Peter L Havens ◽  
Jayesh C Thakker
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Pediatric Patients ◽  
Over Time

scholarly journals The radiological interpretation of possible microbleeds after moderate or severe traumatic brain injury: a longitudinal study

2021 ◽  
Author(s):  
Anke W. van der Eerden ◽  
Thomas L. A. van den Heuvel ◽  
Marnix C. Maas ◽  
Priya Vart ◽  
Pieter E. Vos ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Longitudinal Study ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Time Points ◽  
Computer Aided ◽  
Clinical Consequences ◽  
Severe Tbi ◽  
Over Time

Abstract Introduction In order to augment the certainty of the radiological interpretation of “possible microbleeds” after traumatic brain injury (TBI), we assessed their longitudinal evolution on 3-T SWI in patients with moderate/severe TBI. Methods Standardized 3-T SWI and T1-weighted imaging were obtained 3 and 26 weeks after TBI in 31 patients. Their microbleeds were computer-aided detected and classified by a neuroradiologist as no, possible, or definite at baseline and follow-up, separately (single-scan evaluation). Thereafter, the classifications were re-evaluated after comparison between the time-points (post-comparison evaluation). We selected the possible microbleeds at baseline at single-scan evaluation and recorded their post-comparison classification at follow-up. Results Of the 1038 microbleeds at baseline, 173 were possible microbleeds. Of these, 53.8% corresponded to no microbleed at follow-up. At follow-up, 30.6% were possible and 15.6% were definite. Of the 120 differences between baseline and follow-up, 10% showed evidence of a pathophysiological change over time. Proximity to extra-axial injury and proximity to definite microbleeds were independently predictive of becoming a definite microbleed at follow-up. The reclassification level differed between anatomical locations. Conclusions Our findings support disregarding possible microbleeds in the absence of clinical consequences. In selected cases, however, a follow-up SWI-scan could be considered to exclude evolution into a definite microbleed.

scholarly journals 1575: THERAPEUTIC INTENSITY AND TREATMENT OF HYPERTHERMIA IN SEVERE TRAUMATIC BRAIN INJURY

2021 ◽  
Vol 50 (1) ◽  
pp. 791-791
Author(s):  
Mohamed Almuqamam ◽  
Brian Novi ◽  
Ajit Mammen ◽  
Ryan DeSanti
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Therapeutic Intensity

scholarly journals Feasibility of individualised severe traumatic brain injury management using an automated assessment of optimal cerebral perfusion pressure: the COGiTATE phase II study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030727 ◽  
Author(s):  
Erta Beqiri ◽  
Peter Smielewski ◽  
Chiara Robba ◽  
Marek Czosnyka ◽  
Manuel Teixeira Cabeleira ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cerebral Perfusion Pressure ◽  
Severe Traumatic Brain Injury ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Large Body ◽  
Intervention Group ◽  
Intensity Level ◽  
Brain Trauma Foundation

IntroductionIndividualising therapy is an important challenge for intensive care of patients with severe traumatic brain injury (TBI). Targeting a cerebral perfusion pressure (CPP) tailored to optimise cerebrovascular autoregulation has been suggested as an attractive strategy on the basis of a large body of retrospective observational data. The objective of this study is to prospectively assess the feasibility and safety of such a strategy compared with fixed thresholds which is the current standard of care from international consensus guidelines.Methods and analysisCPPOpt Guided Therapy: Assessment of Target Effectiveness (COGiTATE) is a prospective, multicentre, non-blinded randomised, controlled trial coordinated from Maastricht University Medical Center, Maastricht (The Netherlands). The other original participating centres are Cambridge University NHS Foundation Trust, Cambridge (UK), and University Hospitals Leuven, Leuven (Belgium). Adult severe TBI patients requiring intracranial pressure monitoring are randomised within the first 24 hours of admission in neurocritical care unit. For the control arm, the CPP target is the Brain Trauma Foundation guidelines target (60–70 mm Hg); for the intervention group an automated CPP target is provided as the CPP at which the patient’s cerebrovascular reactivity is best preserved (CPPopt). For a maximum of 5 days, attending clinicians review the CPP target 4-hourly. The main hypothesis of COGiTATE are: (1) in the intervention group the percentage of the monitored time with measured CPP within a range of 5 mm Hg above or below CPPopt will reach 36%; (2) the difference in between groups in daily therapy intensity level score will be lower or equal to 3.Ethics and disseminationEthical approval has been obtained for each participating centre. The results will be presented at international scientific conferences and in peer-reviewed journals.Trial registration numberNCT02982122

scholarly journals Concussion One Hour Later

Concussion ◽  
2019 ◽  
pp. 45-48
Author(s):  
Brian Hainline ◽  
Lindsey J. Gurin ◽  
Daniel M. Torres
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Imaging ◽  
Brain Damage ◽  
Severe Traumatic Brain Injury ◽  
Metabolic Dysfunction ◽  
Singular Event ◽  
Initial Injury ◽  
The Individual ◽  
Over Time

Concussion is not a singular event, but rather a neurological process that may evolve over minutes to hours. Individuals with uncomplicated concussion may develop either increased or new symptoms during the first several hours following the initial injury, yet such symptoms do not result from progressive brain damage but rather a functional cascade of metabolic dysfunction. Any individual with suspected concussion should be monitored serially, as symptoms may evolve over time. When worsening symptoms do not manifest with worrisome neurologic signs, the individual does not require urgent transfer to a hospital and does not need urgent brain imaging studies. Therefore, concussion symptom evolution should be anticipated and distinguished from more severe traumatic brain injury.

Sign in / Sign up

Export Citation Format

Share Document