scholarly journals A clinical practice evaluating the more appropriate airway humidification methods applied on patients with severe traumatic brain injury

2020 ◽  
Author(s):  
xiaohong yin ◽  
Banyou MA ◽  
Lei YANG ◽  
Hua SUN ◽  
Zhilei YUN ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Secondary Infection ◽  
Formation Rate ◽  
Nursing Workload ◽  
Airway Humidification ◽  
Group A ◽  
Group B ◽  
Heat And Moisture

Abstract Airway humidification is an essential treatment for severe traumatic brain injury (STBI) patients after tracheotomy. To date, there was no relevant quantitative study evaluating these humidification ways and providing the appropriate method for the long-term nursing of these patients. In this study, 150 patients whom received tracheotomy treatment in our hospital from January 2016 to November 2018 were recruited into this study. Subjects were divided into three groups according to the humidification way that they received. The groups were oxygen spraying group (group A), Heat and moisture exchanger (HME) group (group B) and the heating and humidification group (group C). Phlegm viscosity, humidification effect, phlegm formation rate, daily sputum inhalation times, airway spasm, secondary lung infection, daily nursing times, nurses' internal satisfaction were evaluated. The C method is superior to both A and B methods in most aspects. A method trends to happening with insufficient or excessive humidification. Phlegm scab formation is significantly less in group C. The B and C methods had equal humidification effects and need similar daily sputum inhalation nursing. Airway spasm was frequent happened in group A than that in groups B and C. Secondary infection happened in all groups, the number of infected patients showed a decreasing trend and the infection degree showed no difference in the first 7 days between group C and group A. And the severity but not the infection ratio significantly decreased in Group C on the 30 th day. Method A significantly reduced nursing workload, but gained the worst humidification effects. Collectively, C method is more suitable for the airway nursing of patients with severe traumatic brain injury.

Severe Head Injury Management at a Tertiary Care Hospital in Dhaka City

2020 ◽  
Vol 6 (2) ◽  
pp. 124-128
Author(s):  
Md Monzurul Haque ◽  
Monsur Ahmed ◽  
Fazlul Haque ◽  
Md Shariful Islam ◽  
Rustom Ali Modhu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Tertiary Care ◽  
Care Hospital ◽  
Good Recovery ◽  
Midline Shift ◽  
Severe Tbi ◽  
Group A ◽  
Group B

Background: Severe traumatic brain injury can be a serious condition. Objective: The purpose of the present study was to see the decompressive craniectomy (DC) of severe traumatic brain injury. Methodology: This clinical trial was conducted in the Department of Neurosurgery at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2012 to December 2013 for a period of two (02) years. Patients with the age of 18 years and above, GCS of the patients 8 to 4, severe traumatic brain injury (TBI) with multiple hemorrhagic contusions and midline shift, on CT scan and severe TBI with gradual neurological deterioration were included for this study. Total 60 patients were included. Result: A total of 60 patients were included in this study. Almost two third 18 (60.0%) patients had favorable outcome (GOS 4 and 5) in group A and exactly two third 20(66.7%) patients had Unfavorable outcome (GOS 1,2 and 3) in group B (p<0.05). In this study 8 patient died among which 5 had GCS 4 and 3 had GCS 5. One patient with GCS 5 became persistent vegetative. Eight patient with good recovery had GCS 8, 7 and 6. Death occurred at mean GCS 9±2.mm of midline shift followed by 8± mm in persistent vegetative, 5.67±2.08 mm in severe disability, 4.5±2.88 mm in moderate disability and 3.38±1.06 mm in good recovery. Conclusion: Group A had better clinical outcome than group B. So based on statistical analysis it can be concluded that DC is preferable to conservative management in case of severe TBI. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 124-128

scholarly journals Relationship between Dizziness and the Core Vestibular Projection Injury in Patients with Mild Traumatic Brain Injury

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2070
Author(s):  
Sung-Ho Jang ◽  
Chang-Hoon Bae ◽  
Jae-Woon Kim ◽  
Hyeok-Gyu Kwon
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Injury Severity ◽  
Diffusion Tensor ◽  
Control Group ◽  
Item Score ◽  
Mild Tbi ◽  
Group A ◽  
Group B

Some studies have reported that a core vestibular projection (CVP) injury is associated with dizziness following a brain injury using diffusion tensor tractography (DTT). On the other hand, there has been no DTT study on dizziness caused by a CVP injury in patients with mild traumatic brain injury (TBI). In this study, DTT was used to examine the relationship between dizziness and CVP injury in patients with mild TBI. Forty-three patients with mild TBI and twenty-nine normal subjects were recruited. The patients were classified into two groups based on the dizziness score: group A, patients with a dizziness score less than 2 on the sub-item score for dizziness in the Rivermead Post-concussion Symptoms Questionnaire; group B, patients with a dizziness score above 2. The tract volume (TV) in group B was significantly lower than group A and the control group (p < 0.05). By contrast, the TV in group A was similar to the control group (p > 0.05). Regarding the correlation, the dizziness score of all patients showed a strong negative correlation with the TV of the CVP (r = −0.711, p < 0.05). DTT revealed the CVP injury in patients with dizziness after mild TBI. In addition, the severity of dizziness of these patients was closely related to the injury severity of the CVP.

scholarly journals Selective hypothermia: an experimental study on traumatic brain injury in rats

2008 ◽  
Vol 66 (2b) ◽  
pp. 391-396 ◽  
Author(s):  
Amylcar Edemilson Dvilevicius ◽  
Mirto Nelso Prandini
Keyword(s):  
Traumatic Brain Injury ◽  
Experimental Study ◽  
Brain Injury ◽  
Control Group ◽  
Histopathological Analysis ◽  
Group A ◽  
Cortical Impact ◽  
The Difference ◽  
Group B ◽  
The Right

OBJECTIVE: To evaluate the efficiency of selective hypothermia in the treatment of the traumatic brain injury in rats. METHOD: After the trauma produced for the model of cortical impact, a small craniectomy in the right frontoparietal region was carried through; after the procedure the animals had been divided in two groups of 15 each. Group A, without treatment with hypothermia (control group) and group B, treated with selective hypothermia for a period to 5 to 6 hours. After this time all the animals were sacrificed, their brains had been removed and histopathological analysis was carried through. RESULTS: Comparison between both groups was done using the counting of neurons injured for field. Counting in the control group n=15 had an average of 70.80 neurons injured for field against an average of 21.33 neurons injured for field in group B (submitted to the treatment with hypothermia), with n=15 also. The difference was statiscally significant. CONCLUSION: Based in the quantification of the neurons injured for field, the effectiveness of the treatment with selective hypothermia was demonstrated.

scholarly journals Effects of Intraoperative Lung-Protective Ventilation on Clinical Outcomes in Patients With Traumatic Brain Injury: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Lulu Jiang ◽  
Yujuan Wu ◽  
Yang Zhang ◽  
Dahao Lu ◽  
Keshi Yan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Controlled Trial ◽  
Neurological Complication ◽  
Serum Levels ◽  
Neurological Complications ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Group A ◽  
Group B

Abstract Background: Secondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI). Lung-protective ventilation (LPV) has been proven to improve perioperative oxygenation and lung compliance in some critical patients. This study aimed to investigate whether intraoperative LPV could improve respiratory function and prevent postoperative complications in emergency TBI patients.Methods: Ninety TBI patients were randomly allocated to three groups (1:1:1): Group A, conventional mechanical ventilation [tidal volume (VT) 10mL/kg only]; Group B, small VT (8mL/kg) + positive end-expiratory pressure (PEEP) (5cmH2O); Group C, small VT (8mL/kg) + PEEP (5cmH2O) + recruitment maneuvers (RMs). Primary outcomes were intraoperative respiratory mechanics parameters and incidences of postoperative pulmonary complications; Secondary outcomes were serum levels of brain injury markers and incidences of postoperative neurological complications.Results: Seventy-nine patients completed final analysis. Intraoperative PaO2 and dynamic pulmonary compliance of Group B and C were higher than those of Group A (P=0.028; P=0.005), while their airway peak pressure and plateau pressure were lower than those of group A (P=0.004; P=0.005). Compared to Group A, postoperative 30-day incidences of hypoxemia, pulmonary infection and atelectasis of the other two groups significantly decreased (52.0% vs. 14.3% vs. 19.2%, P=0.005; 84.0% vs. 50.0% vs. 42.3%, P=0.006; 24.0% vs. 3.6% vs. 0.0%, P=0.004). Moreover, intraoperative hypotension in Group C was more frequent than that in Group A and B (P=0.007). At the end of surgery, serum levels of glial fibrillary acidic protein and ubiquitin carboxyl-terminal hydrolase isozyme L1 in Group B were lower than those in group A and C (P=0.002; P<0.001). Postoperative incidences of neurological complications among three groups were comparable. Conclusions: Intraoperative continuous administration of small VT + PEEP is beneficial to TBI patients. Additional RMs with caution can be performed to prevent the disturbance of the stability of cerebral hemodynamics.Trial registration: Chinese Clinical Trial Registry (ChiCTR2000038314), retrospectively registered on September 17, 2020.

Effects and Mechanism of Mouse Nerve Growth Factor on Diffuse Brain Injury in Rats with Traumatic Brain Injury Combined with Seawater Drowning

2021 ◽  
Vol 11 (12) ◽  
pp. 2321-2328
Author(s):  
Zihuan Zeng ◽  
Hao Zhang ◽  
Jianwu Wu ◽  
Liangfeng Wei ◽  
Weiqiang Chen ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Nerve Growth Factor ◽  
Brain Injury ◽  
Growth Factor ◽  
Cell Swelling ◽  
Nerve Growth ◽  
Diffuse Brain Injury ◽  
Severity Scores ◽  
Group A ◽  
Group B

To investigate the effect of mouse nerve growth factor (mNGF) on axonal injury after traumatic brain injury (TBI) combined with seawater drowning (SWD) in rats and the possible mechanism, we assigned 78 SD rats by random into sham group (Group A, n = 14), TBI+SWD group (Group B, n = 32), and mNGF group (Group C, n = 32). The compound injury model of rats was established by Marmarou method (450 g×1.5 m) and intratracheal pumping seawater (3 ml/kg). Rats in Group C were subject to intraperitoneal injection of mNGF (3 ug/kg) immediately after injury, and Group A as well as Group B were intraperitoneally injected the same amount of normal saline. Modified neurological severity scores(mNSS) was performed on rats at 12 h, 24 h, 72 h as well as 168 h, respectively after injury. HE staining showed that 24 h after injury, the swelling of nerve cells in Group C was relatively milder and the tissue edema was similar to that in Group B. At 72 h and 168 h after injury, the matrix looseness, cell swelling, and nuclear condensation in Group C were improved in comparison with Group B. (2) Compared with group B, mNSS of group C decreased signally at 72 h and 68 h after injury (P <0.05). (3) IHC staining showed that the protein expressions of β-APP, NF-L, and AQP4 were decreased in Group C in comparison with Group B at 12 h, 24 h, 72 h and 168 h after injury. (4) Brain water content in Group C was similar to that in Group B (P >0.05). (5) At 12 h after injury, the expression of TNF-α in Group C was signally lower than that in Group B (P < 0.05). Our reseache showed that mNGF might play a neuroprotective role by reducing cerebral edema and inflammatory response after TBI+SWD injury in rats, thereby restoring part of the injured axons in TBI+SWD rats.

scholarly journals The value of anti-epileptic therapy as a prophylactic factor for seizures in the management of moderate traumatic brain injury

2020 ◽  
Vol 6 (10) ◽  
pp. FSO622
Author(s):  
Konstantinos Faropoulos ◽  
Demosthenes Makris ◽  
George Fotakopoulos
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Prior History ◽  
Injury Occurrence ◽  
Anti Epileptic Drug ◽  
Moderate Traumatic Brain Injury ◽  
History Of ◽  
Group A ◽  
Post Traumatic ◽  
Group B

Aim: The value of anti-epileptic therapy in the prophylaxis of post-traumatic seizures. Patients & methods: All patients received a standard anti-epileptic drug (AED) and were divided into two groups: Group A -with early AED and Group B -with late AED. Results: Patients (871/1062) met the inclusion criteria. Multivariate analysis demonstrated that computer tomography findings, headache and prior history of brain head injury were independent risk factors of seizures. Only late post-traumatic seizures (LPTS) was significantly associated with AED (p < 0.05). Conclusion: Early treatment with AED seems to not affect the incidence of lPTS. In addition, an AED with a mean time of initiation of 7.5 days from the moderate traumatic brain injury occurrence could reduce the lPTS incidence.

scholarly journals Efficacy of Neuroprotection from Curcumin through Heat Shock Protein 70 Induction in Traumatic Brain Injury – Rat Model

2020 ◽  
Vol 8 (A) ◽  
pp. 593-596
Author(s):  
Suzy Indharty ◽  
Iskandar Japardi ◽  
Steven Tandean ◽  
Andre M. P. Siahaan ◽  
Michael Lumintang Loe ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Treatment Group ◽  
Heat Shock Protein 70 ◽  
Caspase 3 ◽  
Tunel Assay ◽  
Hsp 70 ◽  
Significant Difference ◽  
Group A ◽  
Group B

BACKGROUND: Traumatic brain injury (TBI) is the most common problem that caused morbidity and mortality in the world. Secondary brain injury is a complex cascade that causes brain cell apoptosis. Curcumin is a natural product that has neuroprotective properties. AIM: This study aimed to investigate the effect of curcumin toward heat shock protein 70 (HSP 70) expression against the expression apoptosis marker (apoptosis-inducing factor [AIF], caspase-3, and TUNEL assay) in brain tissue after TBI. METHODS: Thirty-three Sprague Dawley rats were randomized into three treatment groups, that is, sham-operated controls, closed head trauma (CHT), and CHT with curcumin extract (treatment group). In the treatment group, curcumin was given 500 mg/kg per oral for 7 days, then brain tissues were investigated (marker AIF, caspase-3, TUNEL assay, and HSP 70) through immunohistochemistry. Statistical test using one-way ANOVA test and Tukey honestly significant difference as post hoc test. RESULTS: The mean of positive AIF stained cells in Group A was 5.36 ± 2.11, Group B was 12.82 ± 1.40, and Group C was 3.82 ± 1.40, with a significant difference of AIF expression between Groups C and B (p < 0.05). Mean of positive caspase-3 stained cells in Group A was 5.45 ± 2.30, Group B was 13.82 ± 2.44, and Group C was 3.82 ± 1.54, with a significant difference of caspase-3 expression between Groups C and B (p < 0.05). Mean of positive TUNEL assay stained cells in Group A was 4.82 ± 2.04, Group B was 11.55 ± 1.51, and Group C was 3.55 ± 1.70, with a significant difference between Groups C and B (p < 0.05). Mean of positive HSP 70 stained cells in Group A was 6.82 ± 2.14, Group B was 3.91 ± 2.26, and Group C was 10.27 ± 2.45 with a significant difference of HSP 70 expression distribution within groups (p < 0.05). CONCLUSION: Curcumin may protect brain cells from apoptosis after close head trauma by upregulated HSP 70 expression.

scholarly journals Effects of intraoperative lung-protective ventilation on clinical outcomes in patients with traumatic brain injury: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lulu Jiang ◽  
Yujuan Wu ◽  
Yang Zhang ◽  
Dahao Lu ◽  
Keshi Yan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Controlled Trial ◽  
Neurological Complication ◽  
Serum Levels ◽  
Pulmonary Complications ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Group A ◽  
Group B

Abstract Background Secondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI). Lung-protective ventilation (LPV) has been proven to improve perioperative oxygenation and lung compliance in some critical patients. This study aimed to investigate whether intraoperative LPV could improve respiratory function and prevent postoperative complications in emergency TBI patients. Methods Ninety TBI patients were randomly allocated to three groups (1:1:1): Group A, conventional mechanical ventilation [tidal volume (VT) 10 mL/kg only]; Group B, small VT (8 mL/kg) + positive end-expiratory pressure (PEEP) (5 cmH2O); and Group C, small VT (8 mL/kg) + PEEP (5 cmH2O) + recruitment maneuvers (RMs). The primary outcome was the incidence of total postoperative pulmonary complications; Secondary outcomes were intraoperative respiratory mechanics parameters and serum levels of brain injury markers, and the incidence of each postoperative pulmonary and neurological complication. Results Seventy-nine patients completed the final analysis. The intraoperative PaO2 and dynamic pulmonary compliance of Groups B and C were higher than those of Group A (P = 0.028; P = 0.005), while their airway peak pressure and plateau pressure were lower than those of group A (P = 0.004; P = 0.005). Compared to Group A, Groups B and C had decreased 30-day postoperative incidences of total pulmonary complications, hypoxemia, pulmonary infection, and atelectasis (84.0 % vs. 57.1 % vs. 53.8 %, P = 0.047; 52.0 % vs. 14.3 % vs. 19.2 %, P = 0.005; 84.0 % vs. 50.0 % vs. 42.3 %, P = 0.006; 24.0 % vs. 3.6 % vs. 0.0 %, P = 0.004). Moreover, intraoperative hypotension was more frequent in Group C than in Groups A and B (P = 0.007). At the end of surgery, the serum levels of glial fibrillary acidic protein and ubiquitin carboxyl-terminal hydrolase isozyme L1 in Group B were lower than those in Groups A and C (P = 0.002; P < 0.001). The postoperative incidences of neurological complications among the three groups were comparable. Conclusions Continuous intraoperative administration of small VT + PEEP is beneficial to TBI patients. Additional RMs can be performed with caution to prevent disturbances in the stability of cerebral hemodynamics. Trial registration Chinese Clinical Trial Registry (ChiCTR2000038314), retrospectively registered on September 17, 2020.

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