scholarly journals Enhanced prehospital volume therapy does not lead to improved outcomes in severely injured patients with severe traumatic brain injury

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Bjoern Hussmann ◽  
Carsten Schoeneberg ◽  
Pascal Jungbluth ◽  
Matthias Heuer ◽  
Rolf Lefering ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Severely Injured ◽  
Volume Therapy ◽  
Severely Injured Patients ◽  
Improved Outcomes ◽  
Injured Patients

scholarly journals Traumatic brain injury is associated with increased syndecan-1 shedding in severely injured patients

2018 ◽  
Vol 26 (1) ◽  
Author(s):  
Erika Gonzalez Rodriguez ◽  
Jessica C. Cardenas ◽  
Charles S. Cox ◽  
Ryan S. Kitagawa ◽  
Jakob Stensballe ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Injured Patients

scholarly journals Age and traumatic brain injury as prognostic factors for late-phase mortality in patients defined as polytrauma according to the New Berlin Definition: experiences from a level I trauma center

2020 ◽  
Author(s):  
V. Weihs ◽  
V. Heel ◽  
M. Dedeyan ◽  
N. W. Lang ◽  
S. Frenzel ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Prognostic Factors ◽  
Trauma Center ◽  
Late Phase ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Berlin Definition ◽  
Severe Tbi ◽  
Level I ◽  
Injured Patients

Abstract Background The rationale of this study was to identify independent prognostic factors influencing the late-phase survival of polytraumatized patients defined according to the New Berlin Definition. Methods Retrospective data analysis on 173 consecutively polytraumatized patients treated at a level I trauma center between January 2012 and December 2015. Patients were classified into two groups: severely injured patients (ISS > 16) and polytraumatized patients (patients who met the diagnostic criteria for the New Berlin Definition). Results Polytraumatized patients showed significantly lower late-phase and overall survival rates. The presence of traumatic brain injury (TBI) and age > 55 years had a significant influence on the late-phase survival in polytraumatized patients but not in severely injured patients. Despite the percentage of severe TBI being nearly identical in both groups, severe TBI was identified as main cause of death in polytraumatized patients. Furthermore, severe TBI remains the main cause of death in polytraumatized patients > 55 years of age, whereas younger polytraumatized patients (< 55 years of age) tend to die more often due to the acute trauma. Conclusion Our results suggest that age beyond 55 years and concomitant (severe) TBI remain as most important influencing risk factor for the late-phase survival of polytraumatized patients but not in severely injured patients. Level of evidence Prognostic study, level III.

scholarly journals Pathophysiology of severe traumatic brain injury and management of intracranial hypertension

2019 ◽  
Vol 18 (2) ◽  
pp. 62-71
Author(s):  
Raimondas Juškys ◽  
Vaiva Hendrixson
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Hypertension ◽  
Severe Traumatic Brain Injury ◽  
Current Treatment ◽  
Secondary Brain Injury ◽  
Management Options ◽  
Treatment Protocols ◽  
Improved Outcomes ◽  
The Brain

It is well recognized that severe traumatic brain injury causes major health and socioeconomic burdens for patients their families and society itself. Over the past decade, understanding of secondary brain injury processes has increased tremendously, permitting implementation of new neurocritical methods of care that substantially contribute to improved outcomes of such patients. The main objective of current treatment protocols is to optimize different physiological measurements that prevent secondary insults and reinforce the ability of the brain to heal. The aim of this literature review is to uncover the pathophysiological mechanisms of severe traumatic brain injury and their interrelationship, including cerebral metabolic crisis, disturbances of blood flow to the brain and development of edema, putting emphasis on intracranial hypertension and its current management options.

scholarly journals Implementation of Neurocritical Care Is Associated With Improved Outcomes in Traumatic Brain Injury

2017 ◽  
Vol 44 (4) ◽  
pp. 350-357 ◽  
Author(s):  
Mypinder S. Sekhon ◽  
Peter Gooderham ◽  
Brian Toyota ◽  
Navid Kherzi ◽  
Vivien Hu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Neurocritical Care ◽  
Injury Severity ◽  
Core Body Temperature ◽  
Therapeutic Interventions ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Improved Outcomes

AbstractBackground Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients. Methods: We conducted a single-center quasi-experimental uncontrolled pre- and post-NCC study in severe traumatic brain injury patients (Glasgow Coma Scale ≤8). The NCC program includes consultation with a neurointensivist and neurosurgeon and multimodal neuromonitoring. Demographic, injury severity metrics, neurophysiologic data, and therapeutic interventions were collected. Glasgow Outcome Scale (GOS) at 6 months was the primary outcome. Multivariable ordinal logistic regression was used to model the association between NCC implementation and GOS at 6 months. Results: A total of 113 patients were identified: 76 pre-NCC and 37 post-NCC. Mean age was 39 years (standard deviation [SD], 2) and 87 of 113 (77%) patients were male. Median admission motor score was 3 (interquartile ratio, 1-4). Daily mean arterial pressure was higher (95 mmHg [SD, 10]) versus (88 mmHg [SD, 10], p<0.001) and daily mean core body temperature was lower (36.6°C [SD, 0.90]) versus (37.2°C [SD, 1.0], p=0.001) post-NCC compared with pre-NCC, respectively. Multivariable regression modelling revealed the NCC program was associated with a 2.5 increased odds (odds ratios, 2.5; 95% confidence interval, 1.1-5.3; p=0.022) of improved 6-month GOS. Conclusions: Implementation of a NCC program is associated with improved 6 month GOS in severe TBI patients.

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