TITLE Role of closed loop INTELLIVENT -ASV mode ventilation in Head Injury patients as compared to conventional ventilation modes. (Preprint)

2021 ◽  
Author(s):  
Sadia Imran
Keyword(s):  
Mechanical Ventilation ◽  
Brain Injury ◽  
Head Injury ◽  
Closed Loop ◽  
Early Stage ◽  
Morbidity And Mortality ◽  
Therapeutic Window ◽  
Secondary Brain Injury ◽  
Primary Injury ◽  
The Brain

BACKGROUND INTRODUCTION Traumatic brain injury (TBI) is common in all hospitals over Pakistan and it is associated with significant morbidity and mortality. It presents with varying levels of severity. Intensive monitoring and early suspicion of complications make it a mandatory sensitive issue. Moderate to severe head injuries require elective and/or emergency mechanical ventilation at an early stage. Hence, choosing an appropriate mode of ventilation and providing optimum ventilation can help prevent secondary brain injury, which result from ischemic and hypoxic changes in the brain due to injury. Mortality and morbidity of head injury coincides directly with the severity of the injury. Moreover, superimposed secondary brain Injury on a primary injury increases the severity of the injury, decreases the time of the therapeutic window and hence increases the morbidity and mortality of the TBI. An appropriate mechanical ventilation therapy at an early stage of a head injury can help preserve the primary injury, decrease the progression to a secondary Injury, prevent a cascade reaction where an Injury imposes further decompression of the brain and hence by decreasing morbidity can help decrease mortality. OBJECTIVE To determine outcomes of head injury patients ventilated with closed loop IntelliVent-ASV mode as compared to conventional SIMV ventilation mode based on maintenance of PEtCO2. METHODS STYDY DESIGN Randomized controlled trial. SETTING POF Hospital, Wah Cantt STUDY PERIOD Six months after approval of synopsis SAMPLING TECHNIQUE Non probability consecutive sampling SAMPLE SIZE A total of 100 patients with head injury fulfilling the inclusion criteria were selected and randomly allocated into two groups containing 50(n) each. RESULTS Data was analysed using SPSS Version 17. EtCO2 was measured continuously via mainstream EtCO2 . The IntelliVent ASV patients were randomally assigned group A while SIMV patients were assigned group B. Mean GCS score among both groups was 6.18+1.27 and 6.22+1.20 .Average EtCO2 reading among both groups was 34.58+2.01 and 35.58+2.12 respectively. Mean no. of manual adjustments among both groups was 7.50+3.40 and 6.25+0.88 respectively. After performing statistical analysis P value was <0.000 which was statistically significant. CONCLUSIONS Closed loop automated mode in head injury patients secure better outcomes than conventional mode in terms of decreased morbidity. Although the study needs more number of patients and time to determine the efficacy of one mode over another. CLINICALTRIAL ISRCTN10127188 https://doi.org/10.1186/ISRCTN10127188

Optimising the management of severe Traumatic Brain Injury in the military maritime environment

2014 ◽  
Vol 100 (3) ◽  
pp. 293-300
Author(s):  
IA Edgar ◽  
G Hadjipavlou ◽  
JE Smith
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Healthcare Systems ◽  
Secondary Brain Injury ◽  
Eye Protection ◽  
Alternative Approaches ◽  
The Military ◽  
Primary Injury ◽  
Maritime Environment

AbstractSevere Traumatic Brain Injury (sTBI) is a devastating cause of morbidity and mortality, especially among those aged less than 45 years. Advances in clinical practice continue to focus on preventing primary injury through developing ballistic head and eye protection, and through minimising secondary brain injury (secondary prevention).Managing sTBI is challenging in well-developed, well-resourced healthcare systems. Achieving management aims in the military maritime environment poses even greater challenges.Strategies for the management of sTBI in the maritime environment should be in keeping with current best evidence. Provision of specialist interventions for sTBI in military maritime environments may require alternative approaches matched to the skills of the staff and environmental restrictions.

Use of hemoglobin-based oxygen-carrying solution–201 to improve resuscitation parameters and prevent secondary brain injury in a swine model of traumatic brain injury and hemorrhage

2008 ◽  
Vol 108 (3) ◽  
pp. 575-587 ◽  
Author(s):  
Guy Rosenthal ◽  
Diane Morabito ◽  
Mitchell Cohen ◽  
Annina Roeytenberg ◽  
Nikita Derugin ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mr Imaging ◽  
Swine Model ◽  
Secondary Brain Injury ◽  
Large Animal ◽  
Fluoro Jade B ◽  
Significant Difference ◽  
Impact Injury ◽  
The Brain

Object Traumatic brain injury (TBI) often occurs as part of a multisystem trauma that may lead to hemorrhagic shock. Effective resuscitation and restoration of oxygen delivery to the brain is important in patients with TBI because hypotension and hypoxia are associated with poor outcome in head injury. We studied the effects of hemoglobin-based oxygen-carrying (HBOC)–201 solution compared with lactated Ringer (LR) solution in a large animal model of brain injury and hemorrhage, in a blinded prospective randomized study. Methods Swine underwent brain impact injury and hemorrhage to a mean arterial pressure (MAP) of 40 mm Hg. Twenty swine were randomized to undergo resuscitation with HBOC-201 (6 ml/kg) or LR solution (12 ml/kg) and were observed for an average of 6.5 ± 0.5 hours following resuscitation. At the end of the observation period, magnetic resonance (MR) imaging was performed. Histological studies of swine brains were performed using Fluoro-Jade B, a marker of early neuronal degeneration. Results Swine resuscitated with HBOC-201 had higher MAP, higher cerebral perfusion pressure (CPP), improved base deficit, and higher brain tissue oxygen tension (PbtO2) than animals resuscitated with LR solution. No significant difference in total injury volume on T2-weighted MR imaging was observed between animals resuscitated with HBOC-201 solution (1155 ± 374 mm3) or LR solution (1246 ± 279 mm3; p = 0.55). On the side of impact injury, no significant difference in the mean number of Fluoro-Jade B–positive cells/hpf was seen between HBOC-201 solution (61.5 ± 14.7) and LR solution (48.9 ± 17.7; p = 0.13). Surprisingly, on the side opposite impact injury, a significant increase in Fluoro-Jade B–positive cells/hpf was seen in animals resuscitated with LR solution (42.8 ± 28.3) compared with those resuscitated with HBOC-201 solution (5.6 ± 8.1; p < 0.05), implying greater neuronal injury in LR-treated swine. Conclusions The improved MAP, CPP, and PbtO2 observed with HBOC-201 solution in comparison with LR solution indicates that HBOC-201 solution may be a preferable agent for small-volume resuscitation in brain-injured patients with hemorrhage. The use of HBOC-201 solution appears to decrease cellular degeneration in the brain area not directly impacted by the primary injury. Hemoglobin-based oxygen-carrying–201 solution may act by improving cerebral blood flow or increasing the oxygen-carrying capacity of blood, mitigating a second insult to the injured brain.

A Model of Metabolic Supply-Demand Mismatch Leading to Secondary Brain Injury

2021 ◽  
Author(s):  
Jiangling Song ◽  
Jennifer A. Kim ◽  
Aaron Frank Struck ◽  
Rui Zhang ◽  
M. Brandon Westover
Keyword(s):  
Brain Injury ◽  
Mechanistic Model ◽  
Acute Brain Injury ◽  
Extracellular Potassium ◽  
Secondary Brain Injury ◽  
Proposed Model ◽  
The Common ◽  
High Level ◽  
The Brain ◽  
Common Association

Secondary brain injury (SBI) is defined as new or worsening injury to the brain after an initial neurologic insult, such as hemorrhage, trauma, ischemic stroke, or infection. It is a common and potentially preventable complication following many types of primary brain injury (PBI). However, mechanistic details about how PBI leads to additional brain injury and evolves into SBI are poorly characterized. In this work, we propose a mechanistic model for the metabolic supply demand mismatch hypothesis (MSDMH) of SBI. Our model, based on the Hodgkin-Huxley model, supplemented with additional dynamics for extracellular potassium, oxygen concentration and excitotoxity, provides a high-level unified explanation for why patients with acute brain injury frequently develop SBI. We investigate how decreased oxygen, increased extracellular potassium, excitotoxicity, and seizures can induce SBI, and suggest three underlying paths for how events following PBI may lead to SBI. The proposed model also helps explain several important empirical observations, including the common association of acute brain injury with seizures, the association of seizures with tissue hypoxia and so on. In contrast to current practices which assume that ischemia plays the predominant role in SBI, our model suggests that metabolic crisis involved in SBI can also be non-ischemic. Our findings offer a more comprehensive understanding of the complex interrelationship among potassium, oxygen, excitotoxicity, seizures and SBI.

Does growth restriction increase the vulnerability to acute ventilation-induced brain injury in newborn lambs? Implications for future health and disease

2017 ◽  
Vol 8 (5) ◽  
pp. 556-565 ◽  
Author(s):  
B. J. Allison ◽  
S. B. Hooper ◽  
E. Coia ◽  
G. Jenkin ◽  
A. Malhotra ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Brain Injury ◽  
Cell Damage ◽  
Inflammatory Marker ◽  
Neurovascular Unit ◽  
Early Brain Injury ◽  
Growth Restriction ◽  
Future Health ◽  
Fetal Sheep ◽  
The Brain

Fetal growth restriction (FGR) and preterm birth are frequent co-morbidities, both are independent risks for brain injury. However, few studies have examined the mechanisms by which preterm FGR increases the risk of adverse neurological outcomes. We aimed to determine the effects of prematurity and mechanical ventilation (VENT) on the brain of FGR and appropriately grown (AG, control) lambs. We hypothesized that FGR preterm lambs are more vulnerable to ventilation-induced acute brain injury. FGR was surgically induced in fetal sheep (0.7 gestation) by ligation of a single umbilical artery. After 4 weeks, preterm lambs were euthanized at delivery or delivered and ventilated for 2 h before euthanasia. Brains and cerebrospinal fluid (CSF) were collected for analysis of molecular and structural indices of early brain injury. FGRVENT lambs had increased oxidative cell damage and brain injury marker S100B levels compared with all other groups. Mechanical ventilation increased inflammatory marker IL-8 within the brain of FGRVENT and AGVENT lambs. Abnormalities in the neurovascular unit and increased blood–brain barrier permeability were observed in FGRVENT lambs, as well as an altered density of vascular tight junctions markers. FGR and AG preterm lambs have different responses to acute injurious mechanical ventilation, changes which appear to have been developmentally programmed in utero.

scholarly journals Factors Affecting Traumatic Brain Injury Outcome Among Patients Treated for Head Injury at Surgical Side, in Nekemte Referral Hospital, Oromia, Ethiopia.

2020 ◽  
Vol 1 (2) ◽  
pp. 1-13
Author(s):  
Mitiku Getachew Kumara ◽  
Miresa Banti Dhugasa
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Conservative Management ◽  
Referral Hospital ◽  
Time Interval ◽  
Secondary Brain Injury ◽  
Major Public Health Problem ◽  
Delayed Presentation ◽  
Unfavourable Outcome

Background Traumatic brain injury is an expanding major public health problem and the leading cause of death of the young and productive part of the world’s population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. Only few studies have examined prognostic factors of traumatic brain injury outcome in developing countries including Ethiopia. This study was aimed at defining the peculiar demographic and other associated factors of traumatic brain injury (TBI) outcome among patients treated for head injury at Nekemte Referral Hospital. Objective The main purpose of this study was to describe the magnitude of TBI outcome and assess factors associated with unfavourable outcome of TBI among patients treated for head injury at the surgical side in Nekemte Referral Hospital from July 8, 2016 to July 7, 2018. Methods A retrospective cross-sectional document review was conducted among TBI patients treated for head injury from July 8, 2016 to July 7, 2018 at Nekemte Referral Hospital. Data were collected using a pre-tested data collection format. Data analysis was done using SPSS version 20. Descriptive statistics were computed and association between the dependent and independent variables were assessed by using logistic regression. Odds ratios with 95% confidence interval were computed. Significant association was declared when the p value was <0.05. Results In this study, out of 378 cases 95 (25.1%) were discharged with unfavourable outcome of which 37(9.8%) were neurologic deficits and 58 were deaths giving overall mortality rate of 15.3%. Patient age>60years (AOR: 15.13; 95%CI: 3.575-64.028), time interval from injury to treatment (AOR: 16.054; 95%CI: 5.832-44.194), low GCS (AOR: 18.224; 95%CI: 4.167, 79.695), conservative management (AOR: 20.774; 95%CI: 6.106-70.681), pupils abnormality (AOR: 9.078; 95%CI: AOR: 2.996-27.509) were associated with unfavourable outcome. Conclusions A quarter of patients treated for TBI at Nekemte Referral Hospital are discharged with unfavourable outcomes. Old age, delayed presentation to the hospital, low GCS, conservative management, and pupillary abnormality increase the odds of unfavourable outcome. Timely management of TBI before patients develop secondary brain injury and use of surgical intervention based on CT scan diagnosis will reduce the occurrence of unfavourable outcome.

Pediatric Minor Head Injury and Concussion

2018 ◽  
Author(s):  
Chad Scarboro ◽  
Simone Lawson
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Mild Traumatic Brain Injury ◽  
Head Injuries ◽  
Normal Activity ◽  
Secondary Brain Injury ◽  
Wide Range ◽  
Serious Injuries

Head injury is one of the most common reasons children present to the emergency department (ED) and the leading cause of pediatric death and disability. Head injuries can range from having no neurologic deficits to death. Management in the ED centers on determining if there is a serious brain injury and preventing secondary brain injury. In most cases of mild traumatic brain injury, serious injuries can be ruled out based on the history of the injury, associated symptoms, and clinical assessment. Concussion is a common presentation of head injury and encompasses a wide range of symptoms. Computed tomography should be used judiciously, and extensive research has led to algorithms to aid in this decision. Prior to discharge from the ED, parents will often have questions about when their child may resume normal activity. This is a decision that most often will involve the patient’s primary care provider or a concussion specialist as the ED provider is unable to follow progression or resolution of symptoms. However, the ED provider should be able to provide anticipatory guidance.   Key words: computed tomography, concussion, head injury, mild traumatic brain injury, traumatic brain injury

scholarly journals Animal Models of Post-Traumatic Epilepsy

Diagnostics ◽  
2019 ◽  
Vol 10 (1) ◽  
pp. 4 ◽  
Author(s):  
Kristin A. Keith ◽  
Jason H. Huang
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Animal Models ◽  
Recurrent Seizure ◽  
Post Traumatic ◽  
Post Traumatic Epilepsy ◽  
The Brain ◽  
Underlying Pathophysiology ◽  
Traumatic Epilepsy

Traumatic brain injury is the leading cause of morbidity and mortality worldwide, with the incidence of post-traumatic epilepsy increasing with the severity of the head injury. Post-traumatic epilepsy (PTE) is defined as a recurrent seizure disorder secondary to trauma to the brain and has been described as one of the most devastating complications associated with TBI (Traumatic Brain Injury). The goal of this review is to characterize current animal models of PTE and provide succinct protocols for the development of each of the currently available animal models. The development of translational and effective animal models for post-traumatic epilepsy is critical in both elucidating the underlying pathophysiology associated with PTE and providing efficacious clinical breakthroughs in the management of PTE.

scholarly journals The effect of different atmosphere absolute hyperbaric oxygen on the expression of extracellular histones after traumatic brain injury in rats

2020 ◽  
Vol 25 (6) ◽  
pp. 1013-1024
Author(s):  
Fang Liang ◽  
Lei Sun ◽  
Jing Yang ◽  
Xue-Hua Liu ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hyperbaric Oxygen ◽  
Early Stage ◽  
Secondary Brain Injury ◽  
Injury Group ◽  
Extracellular Histones ◽  
The One ◽  
Time Specific ◽  
Traumatic Brain Injury Group

Abstract By observing the dynamic changes of extracellular histones H1, H2A, H4, and NF-κB expression in brain tissues after brain injury in rats, we explore the association among the expression of extracellular histones H1, H2A, H4, and NF-κB following traumatic brain injury (TBI), as well as the effect of different atmospheres absolute hyperbaric oxygen (HBO) intervention on the expression and possible mechanisms. A total of 120 SD rats were randomly divided into 4 groups: Sham-operated (SH), TBI (traumatic brain injury) group, traumatic brain injury and hyperbaric oxygen treatment 1.6ATA (TBI + HBO1) group, and traumatic brain injury and hyperbaric oxygen treatment2.2ATA (TBI + HBO2) group, with 30 rats in each group. The rats in each group were then randomly divided into five smaller time-specific sub-groups: 3 h, 6 h, 12 h, 24 h, and 48 h after surgery. TBI models were established, and the brain tissue around the lesion was taken at different time points. On the one hand,we detected the level of local histones H1, H2A, H4, and NF-κB by RT-PCR and Western Blot. On the other hand, we used immunohistochemical methods to detect the expression of NF-κB, while using the TUNEL method to observe the cell apoptosis in experimental groups after brain injury. Extracellular histones H1, H2A, H4, and NF-κB proteins were highly expressed at 3 h, then with a slight fluctuation, reached to peak at 48 h after the injury. HBO can affect the expression of histones H1, H2A, H4, and NF-κB. The decline of each indicator in the 1.6ATA group was significantly lower than that in the 2.2ATA group, especially within 6 h (P < 0. 05). In addition, NF-κB expression was consistent with the pathological changes of apoptosis in experimental groups. Hyperbaric oxygen therapy with relatively low pressure (1.6ATA) at the early stage can significantly inhibit the expression of extracellular histones H1, H2A, H4, and NF-κB around the lesion, reduce the apoptosis of nerve cells, and thus play an important role in alleviating secondary brain injury.

scholarly journals The Effect of Mechanical Ventilation on TASK-1 Expression in the Brain in a Rat Model

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Buqi Na ◽  
Hong Zhang ◽  
Guangfa Wang ◽  
Li Dai ◽  
Guoguang Xia
Keyword(s):  
Mechanical Ventilation ◽  
Brain Injury ◽  
Lung Injury ◽  
Rat Model ◽  
Central Control ◽  
Sprague Dawley ◽  
Sprague Dawley Rats ◽  
Lung Histology ◽  
Respiratory Centre ◽  
The Brain

Background and Objective. TWIK-related acid-sensitive potassium channel 1 (TASK-1) is closely related to respiratory central control and neuronal injury. We investigated the effect of MV on TASK-1’s functions and explored the mechanism using a rat model.Methods. Male Sprague-Dawley rats were randomized to three groups:(1)high tidal volume (HVt): MV for four hours with Vt at 10 mL/kg;(2)low Vt (LVt): MV for four hours with Vt at 5 mL/kg;(3)basal (BAS): anesthetized and unventilated animals. We measured lung histology and plasma and brain levels of proteins (IL-6, TNF-α, and S-100B) and determined TASK-1 levels in rat brainstems as a marker of respiratory centre activity.Results. The LISs (lung injury scores) were significantly higher in the HVt group. Brain inflammatory cytokines levels were different to those in serum. TASK-1 levels were significantly lower in the MV groups (P=0.002) and the HVt group tended to have a lower level of TASK-1 than the LVt group.Conclusion. MV causes not only lung injury, but also brain injury. MV affects the regulation of the respiratory centre, perhaps causing damage to it. Inflammation is probably not the main mechanism of ventilator-related brain injury.

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