Ketamine in acute phase of severe traumatic brain injury “an old drug for new uses?”

AbstractMaintaining an adequate level of sedation and analgesia plays a key role in the management of traumatic brain injury (TBI). To date, it is unclear which drug or combination of drugs is most effective in achieving these goals. Ketamine is an agent with attractive pharmacological and pharmacokinetics characteristics. Current evidence shows that ketamine does not increase and may instead decrease intracranial pressure, and its safety profile makes it a reliable tool in the prehospital environment. In this point of view, we discuss different aspects of the use of ketamine in the acute phase of TBI, with its potential benefits and pitfalls.

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Lipofundin®-Induced Intracranial Pressure Rise after Severe Traumatic Brain Injury - A Case Report

Zentralblatt für Neurochirurgie ◽

10.1055/s-2004-816270 ◽

2004 ◽

Vol 65 (02) ◽

pp. 81-83 ◽

Cited By ~ 2

Author(s):

S Wolf ◽

M Krammer ◽

H Trost ◽

C Lumenta

Keyword(s):

Traumatic Brain Injury ◽

Case Report ◽

Brain Injury ◽

Intracranial Pressure ◽

Severe Traumatic Brain Injury ◽

Pressure Rise

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Correction to: Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study

Annals of Intensive Care ◽

10.1186/s13613-019-0610-z ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

A. Harrois ◽

◽

J. R. Anstey ◽

F. S. Taccone ◽

A. A. Udy ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Cohort Study ◽

Brain Injury ◽

Intracranial Pressure ◽

Severe Traumatic Brain Injury ◽

Serum Sodium ◽

Collaborative Group ◽

Full List ◽

Pressure Changes

Following publication of the original article [1], we were notified that the collaborators’ names part of the “The TBI Collaborative” group has not been indexed in Pubmed. Below the collaborators names full list:

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A Method of Managing Severe Traumatic Brain Injury in the Absence of Intracranial Pressure Monitoring: The Imaging and Clinical Examination Protocol

Journal of Neurotrauma ◽

10.1089/neu.2016.4472 ◽

2018 ◽

Vol 35 (1) ◽

pp. 54-63 ◽

Cited By ~ 15

Author(s):

Randall M. Chesnut ◽

Nancy Temkin ◽

Sureyya Dikmen ◽

Carlos Rondina ◽

Walter Videtta ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Clinical Examination ◽

Severe Traumatic Brain Injury ◽

Intracranial Pressure Monitoring ◽

Pressure Monitoring ◽

Examination Protocol

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Long-term Quality of Life After Decompressive Craniectomy in Severe Traumatic Brain Injury and Stroke

10.21203/rs.3.rs-626876/v1 ◽

2021 ◽

Author(s):

Alex Vicino ◽

Philippe Vuadens ◽

Bertrand Léger ◽

Charles Benaim

Keyword(s):

Quality Of Life ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Acute Phase ◽

Decompressive Craniectomy ◽

Severe Traumatic Brain Injury ◽

Full Time ◽

Stroke Patients

Abstract PurposeDecompressive craniectomy (DC) can rapidly reduce intracranial pressure and save lives in the acute phase of severe traumatic brain injury (TBI) or stroke, but little is known about the long-term outcome after DC. We evaluated quality of life (QoL) a few years after DC for severe TBI/stroke.MethodsThe following data were collected for stroke/TBI patients hospitalized for neurorehabilitation after DC: 1) at discharge, motor and cognitive sub-scores of the Functional Independence Measure (motor-FIM [score 13-91] and cognitive-FIM [score 5-35]) and 2) more than 4 years after discharge, the QOLIBRI health-related QoL (HR-QoL) score (0-100; <60 representing low or impaired QoL) and the return to work (RTW: 0%, partial, 100%)ResultsWe included 88 patients (66 males, median age 38 [interquartile range 26.3-51.0], 65 with TBI/23 stroke); 46 responded to the HR-QoL questionnaire. Responders and non-responders had similar characteristics (age, sex, functional levels upon discharge). Median motor-FIM and cognitive-FIM scores were 85/91 and 27/35, with no significant difference between TBI and stroke patients. Long-term QoL was borderline low for TBI patients and within normal values for stroke patients (score 58.0[42.0-69.0] vs. 67.0[54.0-81.5], p=0.052). RTW was comparable between the groups (62% full time).ConclusionWe already knew that DC can save the lives of TBI or stroke patients in the acute phase and this study suggests that their long-term quality of life is generally quite acceptable.

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Severe Traumatic Brain Injury

10.2310/psych.2403 ◽

2018 ◽

Author(s):

Ryan Martin ◽

Lara Zimmermann ◽

Kee D. Kim ◽

Marike Zwienenberg ◽

Kiarash Shahlaie

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Severe Traumatic Brain Injury ◽

Neurocritical Care ◽

Secondary Brain Injury ◽

Brain Oxygenation ◽

Barbiturate Coma ◽

Blast Traumatic Brain Injury ◽

Penetrating Traumatic Brain Injury

Traumatic brain injury remains a leading cause of death and disability worldwide. Patients with severe traumatic brain injury are best treated with a multidisciplinary, evidence-based, protocol-directed approach, which has been shown to decrease mortality and improve functional outcomes. Therapy is directed at the prevention of secondary brain injury through optimizing cerebral blood flow and the delivery of metabolic fuel (ie, oxygen and glucose). This is accomplished through the measurement and treatment of elevated intracranial pressure (ICP), the strict avoidance of hypotension and hypoxemia, and in some instances, surgical management. The treatment of elevated ICP is approached in a protocolized, tiered manner, with escalation of care occurring in the setting of refractory intracranial hypertension, culminating in either decompressive surgery or barbiturate coma. With such an approach, the rates of mortality secondary to traumatic brain injury are declining despite an increasing incidence of traumatic brain injury. This review contains 3 figures, 5 tables and 69 reference Key Words: blast traumatic brain injury, brain oxygenation, cerebral perfusion pressure, decompressive craniectomy, hyperosmolar therapy, intracranial pressure, neurocritical care, penetrating traumatic brain injury, severe traumatic brain injury

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Experimental model of intracranial hypertension with continuous multiparametric monitoring in swine

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20130126 ◽

2013 ◽

Vol 71 (10) ◽

pp. 802-806 ◽

Cited By ~ 4

Author(s):

Almir Ferreira de Andrade ◽

Matheus Schmidt Soares ◽

Gustavo Cartaxo Patriota ◽

Alessandro Rodrigo Belon ◽

Wellingson Silva Paiva ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Animal Model ◽

Brain Injury ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Severe Traumatic Brain Injury ◽

Transcranial Doppler ◽

Porcine Model ◽

Cerebral Oximetry ◽

Suitable Animal Model

Objective Intracranial hypertension (IH) develops in approximately 50% of all patients with severe traumatic brain injury (TBI). Therefore, it is very important to identify a suitable animal model to study and understand the pathophysiology of refractory IH to develop effective treatments. Methods We describe a new experimental porcine model designed to simulate expansive brain hematoma causing IH. Under anesthesia, IH was simulated with a balloon insufflation. The IH variables were measured with intracranial pressure (ICP) parenchymal monitoring, epidural, cerebral oximetry, and transcranial Doppler (TCD). Results None of the animals died during the experiment. The ICP epidural showed a slower rise compared with parenchymal ICP. We found a correlation between ICP and cerebral oximetry. Conclusion The model described here seems useful to understand some of the pathophysiological characteristics of acute IH.

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Osteopathic Manipulative Treatment to Optimize the Glymphatic Environment in Severe Traumatic Brain Injury Measured With Optic Nerve Sheath Diameter, Intracranial Pressure Monitoring, and Neurological Pupil Index

Cureus ◽

10.7759/cureus.13823 ◽

2021 ◽

Author(s):

Samir Kashyap ◽

James Brazdzionis ◽

Paras Savla ◽

James A Berry ◽

Saman Farr ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Optic Nerve ◽

Intracranial Pressure ◽

Severe Traumatic Brain Injury ◽

Optic Nerve Sheath Diameter ◽

Osteopathic Manipulative Treatment ◽

Pressure Monitoring ◽

Nerve Sheath ◽

Neurological Pupil Index

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Critical Update on the Third Edition of the Guidelines for Managing Severe Traumatic Brain Injury in Children

American Journal of Critical Care ◽

10.4037/ajcc2020228 ◽

2020 ◽

Vol 29 (1) ◽

pp. e13-e18

Author(s):

Karin Reuter-Rice ◽

Elise Christoferson

Keyword(s):

Traumatic Brain Injury ◽

Critical Care ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Current Evidence ◽

Care Providers ◽

The Third ◽

Guideline Document ◽

Severe Tbi ◽

Pediatric Tbi

Background Severe traumatic brain injury (TBI) is associated with high rates of death and disability. As a result, the revised guidelines for the management of pediatric severe TBI address some of the previous gaps in pediatric TBI evidence and management strategies targeted to promote overall health outcomes. Objectives To provide highlights of the most important updates featured in the third edition of the guidelines for the management of pediatric severe TBI. These highlights can help critical care providers apply the most current and appropriate therapies for children with severe TBI. Methods and Results After a brief overview of the process behind identifying the evidence to support the third edition guidelines, both relevant and new recommendations from the guidelines are outlined to provide critical care providers with the most current management approaches needed for children with severe TBI. Recommendations for neuroimaging, hyperosmolar therapy, analgesics and sedatives, seizure prophylaxis, ventilation therapies, temperature control/hypothermia, nutrition, and corticosteroids are provided. In addition, the complete guideline document and its accompanying algorithm for recommended therapies are available electronically and are referenced within this article. Conclusions The evidence base for treating pediatric TBI is increasing and provides the basis for high-quality care. This article provides critical care providers with a quick reference to the current evidence when caring for a child with a severe TBI. In addition, it provides direct access links to the comprehensive guideline document and algorithms developed to support critical care providers.

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