Neurosurgical Critical Care

Mapping Intimacies ◽

10.2310/anes.18400 ◽

2018 ◽

Author(s):

Jose Manuel Sarmiento ◽

Shouri Lahiri

Keyword(s):

Traumatic Brain Injury ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Critical Care ◽

Brain Injury ◽

Injury Severity ◽

Secondary Brain Injury ◽

Spinal Decompression ◽

Cerebral Herniation ◽

Cord Injury

The overarching goal of neurosurgical critical care is to prevent potential deleterious effects of secondary brain injury. The initial management of patients with traumatic brain injury prioritizes the assessment of injury severity and prevention of hypotension and hypoxemia. The assessment of severity in patients with traumatic brain injury is important for determining the need for intubation and need for placement of intracranial monitoring. The stepwise management of increased intracranial pressure following traumatic brain injury is emphasized to prevent cerebral herniation syndromes and cerebral infarcts. Treatment with glucocorticoids following acute spinal cord injury is not recommended. Operative indications for intracranial monitor placement, hemicraniectomy, and spinal decompression are reviewed. This review contains 1 figure, 3 tables and 32 references Key Words: glucocorticoids in spinal cord injury, hemicraniectomy, intracranial hypertension, multimodal monitoring, secondary brain injury, spinal cord injury, spinal decompression, traumatic brain injury

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Caregiver outcomes and interventions: a systematic scoping review of the traumatic brain injury and spinal cord injury literature

Clinical Rehabilitation ◽

10.1177/0269215516639357 ◽

2016 ◽

Vol 31 (1) ◽

pp. 45-60 ◽

Cited By ~ 35

Author(s):

Anne Baker ◽

Samantha Barker ◽

Amanda Sampson ◽

Clarissa Martin

Keyword(s):

Traumatic Brain Injury ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Brain Injury ◽

Injury Severity ◽

Relevant Information ◽

Care Recipient ◽

Positive Outcomes ◽

Negative Outcomes ◽

Cord Injury

Aim: To identify factors reported with negative and positive outcomes for caregivers of the traumatic brain injury and spinal cord injury cohorts, to investigate what interventions have been studied to support carers and to report what effectiveness has been found. Methods: Scoping systematic review. Electronic databases and websites were searched from 1990 to December 2015. Studies were agreed for inclusion using pre-defined criteria. Relevant information from included studies was extracted and quality assessment was completed. Data were synthesised using qualitative methods. Results: A total of 62 studies reported caregiver outcomes for the traumatic brain injury cohort; 51 reported negative outcomes and 11 reported positive outcomes. For the spinal cord injury cohort, 18 studies reported caregiver outcomes; 15 reported negative outcomes and three reported positive outcomes. Burden of care was over-represented in the literature for both cohorts, with few studies looking at factors associated with positive outcomes. Good family functioning, coping skills and social support were reported to mediate caregiver burden and promote positive outcomes. A total of 21 studies further described interventions to support traumatic brain injury caregivers and four described interventions to support spinal cord injury caregivers, with emerging evidence for the effectiveness of problem-solving training. Further research is required to explore the effects of injury severity of the care recipient, as well as caregiver age, on the outcome of the interventions. Conclusion: Most studies reported negative outcomes, suggesting that barriers to caregiving have been established, but not facilitators. The interventions described to support carers are limited and require further testing to confirm their effectiveness.

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