scholarly journals Age-related carbon dioxide reactivity in children after moderate and severe traumatic brain injury

2016 ◽  
Vol 18 (1) ◽  
pp. 73-78 ◽  
Author(s):  
Tensing Maa ◽  
Keith Owen Yeates ◽  
Melissa Moore-Clingenpeel ◽  
Nicole F. O'Brien
Keyword(s):  
Carbon Dioxide ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Minute Ventilation ◽  
Age Groups ◽  
Age Related ◽  
Negative Effect ◽  
Severe Tbi ◽  
Carbon Dioxide Reactivity ◽  
Artery Flow

OBJECTIVE The objective of this study is to assess carbon dioxide reactivity (CO2R) in children following traumatic brain injury (TBI). METHODS This prospective observational study enrolled children younger than 18 years old following moderate and severe TBI. Thirty-eight mechanically ventilated children had daily CO2R testing performed by measuring changes in their bilateral middle cerebral artery flow velocities using transcranial Doppler ultrasonography (TCD) after a transient increase in minute ventilation. The cohort was divided into 3 age groups: younger than 2 years (n = 12); 2 to 5 years old (n = 9); and older than 5 years (n = 17). RESULTS Children younger than 2 years old had a lower mean CO2R over time. The 2–5-year-old age group had higher mean CO2R than younger patients (p = 0.01), and the highest CO2R values compared with either of the other age groups (vs > 5 years old, p = 0.046; vs < 2 years old, p = 0.002). Having a lower minimum CO2R had a statistically significant negative effect on outcome at discharge (p = 0.0413). Impaired CO2R beyond Postinjury Day 4 trended toward having an effect on outcome at discharge (p = 0.0855). CONCLUSIONS Abnormal CO2R is prevalent in children following TBI, and the degree of impairment varies by age. No clinical or laboratory parameters were identified as risk factors for impaired CO2R. Lower minimum CO2R values are associated with worse outcome at discharge.

Abstract 4: The Effect of Prehospital Hypoxia and Hypotension on Outcome in Major Traumatic Brain Injury: A Deadly Combination

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Daniel W Spaite ◽  
Uwe Stolz ◽  
Bentley J Bobrow ◽  
Vatsal Chikani ◽  
Duane Sherrill ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Trauma Center ◽  
Treatment Guidelines ◽  
Controlled Study ◽  
Negative Effect ◽  
Severe Tbi ◽  
The Impact ◽  
The Relationship

BACKGROUND: Hypoxia (HOx) or hypotension (HT) occurring during the EMS management of major traumatic brain injury-TBI reduces survival. However, little is known about the impact of both HOx and HT, occurring together, on outcome. Only a handful of reports have studied the combination of prehospital HOx/HT in TBI and the largest of these only had 14 cases with both. Objectives: To evaluate the associations between mortality and prehospital HOx and HT, both separately and in combination. METHODS: All moderate/severe TBI cases (CDC Barell Matrix Type-1) in the Excellence in Prehospital Injury Care (EPIC) TBI Study (a statewide, before/after controlled study of the impact of implementing the EMS TBI Treatment Guidelines-NIH/NINDS: 1R01NS071049) from 1/1/08-6/30/12 were evaluated [exclusions: age<10; death before ED arrival; EMS O2 saturation-“sat”<11%; EMS SBP less than 40 or greater than 200; missing sat (5.4% of cases) or SBP (3.1% of cases)]. The relationship between mortality and HOx (sat <90) and/or HT (SBP<90) was assessed with crude and adjusted odds ratios (cOR, aOR) using multivariable logistic regression, controlling for important confounders (see Figure) and accounting for clustering by Trauma Center. RESULTS: 9194 cases were included [Median age: 46 (IQR: 26-65); Male: 68.1%]. 8109 (88.2%) had no HOx/HT, 535 (5.8%) had HOx only, 419 (4.6%) had HT only, and 131 (1.4%) had both HOx/HT. The Figure shows the cORs and aORs for death. CONCLUSION: In this large analysis of major TBI, prehospital HOx and HT were associated with significantly increased mortality. However, the combination of HT and HOx together had a profoundly-negative effect on survival even after controlling for significant confounders. In fact, the aOR for death in patients with both HOx/HT was more than 3 times greater than for those with HOx or HT alone. Since the TBI Guidelines emphasize the prevention and treatment of HOx and HT, their implementation has the potential to significantly impact outcome.

scholarly journals THE EFFECT OF A TRAUMATIC BRAIN INJURY ON CHANGES IN THE HEART RATE OF RATS SUBJECT TO VARIOUS MODES OF MOTOR ACTIVITY

2021 ◽  
Vol 10 (4) ◽  
pp. 3310-3315
Author(s):  
Bulat Ildarovich Vakhitov
Keyword(s):  
Traumatic Brain Injury ◽  
Heart Rate ◽  
Brain Injury ◽  
Motor Activity ◽  
Heart Rate Response ◽  
Age Groups ◽  
Preschool Age ◽  
Pronounced Increase ◽  
Age Related ◽  
First Time

For the first time, studies have been conducted to study the reaction of animal heart rate to various modes of motor activity after a traumatic brain injury. It was revealed that on the first day after modeling an open head injury in rats of all age groups, a pronounced increase in heart rate was observed. In this case, the smallest heart rate response to brain injury is observed in animals of immature age. It was found that the implementation of systematic dynamic exercises by animals of mature and preschool age after modeling a craniocerebral injury contributes to a significant decrease in heart rate. A more pronounced formation of training bradycardia is observed in immature animals. It was revealed that limiting motor activity and performing isometric exercises after a traumatic brain injury maintain heart rate at an increased level in all age groups of animals and significantly inhibits the natural, age-related decrease in heart rate in immature animals.

A Prospective Analysis of Derangement of Coagulation Profile in Adult and Pediatric Age Group in Moderate-to-Severe Traumatic Brain Injury

2018 ◽  
Vol 15 (02/03) ◽  
pp. 087-093
Author(s):  
Swarup Sohan Gandhi ◽  
Manish Mann ◽  
Shashikant Jain ◽  
Ugan Singh Meena ◽  
Virendra Deo Sinha
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pediatric Patients ◽  
Age Groups ◽  
Age Group ◽  
Pediatric Age ◽  
Coagulation Profile ◽  
Pediatric Age Group ◽  
Severe Tbi

Abstract Background and Aim of Study Coagulopathy is a common occurrence following traumatic brain injury (TBI). Various studies have reported the incidence and risk factors of coagulopathy and their correlation with poor outcome in adult as well as pediatric age group. In our study, we aim to analyze trauma-induced coagulopathy in adult and pediatric patients. Methods Adult (> 18 years) and pediatric (< 18 years) patients of TBI admitted in the intensive care unit of a trauma center of a tertiary care center had been studied from August 2015 to March 2018. Patients were further subdivided into moderate and severe TBI based on Glasgow Coma Scale (GCS) of 9 to 12 and < 9, respectively. Coagulation profile (prothrombin time [PT], activated partial thromboplastin time [APTT], thrombin time, fibrinogen, and D-dimer) and arterial blood gas (ABG) analysis were done on day of admission and on days 3 and 7. Coagulation profiles were analyzed in both the age groups, and risk factors were studied and correlated with the mortality and morbidity based on the Glasgow outcome score. Results Two hundred patients including 143 adults and 57 pediatric patients were included. Mean age among the adult and pediatric population was 31.51 ± 16.83 and 11.5 ± 5.90 years, respectively. In adults, 96 (83.62%) out of 116 in severe TBI group and 20 (74.07%) out of 27 in moderate TBI group developed coagulopathy, and in pediatric age group, 14 (70%) out of 20 in moderate TBI and 30 (81.08%) out of 37 in severe TBI developed coagulopathy. Midline shift was significantly associated with coagulopathy in both the age groups (p value < 0.039). Mortality was not significantly different in patients with coagulopathy between the age groups, but improved status as per the Glasgow outcome score was more in pediatric age group. Conclusion The development of coagulopathy is a frequent complication in patients with moderate to severe TBI in both age groups. Even though it is not closely associated with death in this study, it may be regarded as a marker of injury severity.

scholarly journals Perceived Barriers to Exercise in Adults with Traumatic Brain Injury Vary by Age

2018 ◽  
Vol 3 (3) ◽  
pp. 47 ◽  
Author(s):  
Shanti Pinto ◽  
Mark Newman ◽  
Mark Hirsch
Keyword(s):  
Physical Activity ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Physical Exercise ◽  
Medical Treatment ◽  
Age Groups ◽  
Perceived Barriers ◽  
Health Concerns ◽  
Barriers To Exercise ◽  
Severe Tbi

Physical activity and exercise are important adjuncts to medical treatment for overall health in individuals with traumatic brain injury (TBI); however, many individuals do not partake in the recommended weekly exercise. The objective of this study was to investigate the barriers to exercise after TBI and determine whether these barriers varied by age. The sample was 172 adults with moderate to severe TBI who completed Barriers to Physical Exercise and Disability (B-PED) survey. Lack of interest, motivation, and energy as well as cost, lack of counseling on exercise by a physician, not having home equipment, and being too lazy were reported as barriers to exercise by all age groups. Those aged 35 to 54-years-old were more likely to report that cost, lack of transportation, having health concerns, not knowing where to exercise, and fear of leaving the home as barriers to exercise than those aged 18 to 34-years-old or 55-years-old and older. Overall, adults with TBI report multiple barriers to exercise, and these barriers vary by age.

The Effect of Age and Pain on Quantitative Sensory Testing Measurements After Moderate-to-Severe Traumatic Brain Injury: Preliminary Findings

2020 ◽  
Vol 22 (3) ◽  
pp. 341-353
Author(s):  
Sabrina Bouferguene ◽  
Alexandra Lapierre ◽  
Pierre Rainville ◽  
Caroline Arbour
Keyword(s):  
Traumatic Brain Injury ◽  
Chronic Pain ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Quantitative Sensory Testing ◽  
Age Groups ◽  
Sensory Testing ◽  
Body Regions ◽  
Severe Tbi ◽  
Effect Of Age

Background: Chronic pain after moderate-to-severe traumatic brain injury (TBI) is associated with notable sensory alterations. Although the incidence of TBI is rapidly growing in older populations, elderly individuals have been largely excluded from sensory testing studies, thus limiting evidence regarding the influence of age on pain-related sensory alterations after TBI. This study aimed to investigate the effect of age on the sensory profiles of patients with and without chronic pain after moderate-to-severe TBI. Methods: Thermal and mechanical quantitative sensory testing were performed on the painful and contralateral body regions in TBI participants with pain (TBI-P) and on both forearms in TBI participants without pain (TBI-NP). Descriptive information about chronic pain and psychological comorbidities was assessed using validated questionnaires. Results: Participants included 37 young (18–59 years, 57% with chronic pain) and 22 elderly (≥60 years, 46% with chronic pain) survivors of moderate-to-severe TBI. TBI-P participants exhibited significant alterations in heat and pressure pain sensitivity compared to TBI-NP participants, with more pronounced decreases in heat detection in the elderly group and increased warmth sensitivity in the young group. Alterations were not always associated with chronic pain, as cold hypoesthesia was found in elderly TBI-NP participants. In both age groups, chronic pain was associated with higher levels of depressive mood. Conclusions: Results suggest that young and elderly TBI survivors have both common and unique sensory properties, highlighting the need to pursue sensory testing studies in older patient groups. Depression might also be an important target for pain management after TBI.

scholarly journals Age- and Severity-Related In-Hospital Mortality Trends and Risks of Severe Traumatic Brain Injury in Japan: A Nationwide 10-Year Retrospective Study

2021 ◽  
Vol 10 (5) ◽  
pp. 1072 ◽  
Author(s):  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Masayasu Gakumazawa ◽  
Mafumi Shinohara ◽  
Takeru Abe ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Injury Severity ◽  
Mortality Trend ◽  
Mortality Trends ◽  
Age Related ◽  
Severe Tbi ◽  
Gcs Score

Traumatic brain injury (TBI) is the major cause of mortality and morbidity in severely-injured patients worldwide. This retrospective nationwide study aimed to evaluate the age- and severity-related in-hospital mortality trends and mortality risks of patients with severe TBI from 2009 to 2018 to establish effective injury prevention measures. We retrieved information from the Japan Trauma Data Bank dataset between 2009 and 2018. The inclusion criteria for this study were patients with severe TBI defined as those with an Injury Severity Score ≥ 16 and TBI. In total, 31,953 patients with severe TBI (32.6%) were included. There were significant age-related differences in characteristics, mortality trend, and mortality risk in patients with severe TBI. The in-hospital mortality trend of all patients with severe TBI significantly decreased but did not improve for patients aged ≤ 5 years and with a Glasgow Coma Scale (GCS) score between 3 and 8. Severe TBI, age ≥ 65 years, fall from height, GCS score 3–8, and urgent blood transfusion need were associated with a higher mortality risk, and mortality risk did not decrease after 2013. Physicians should consider specific strategies when treating patients with any of these risk factors to reduce severe TBI mortality.

Challenges and Opportunities for Neuroimaging in Young Patients with Traumatic Brain Injury: a Coordinated Effort towards Advancing Discovery from the ENIGMA Pediatric Moderate/Severe TBI Group

2019 ◽  
Author(s):  
Emily L. Dennis ◽  
Karen Caeyenberghs ◽  
Robert F. Asarnow ◽  
Talin Babikian ◽  
Brenda Bartnik-Olson ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Young Patients ◽  
Future Research ◽  
Childhood And Adolescence ◽  
Developmental Issues ◽  
Challenges And Opportunities ◽  
Severe Tbi ◽  
Advance Research

Traumatic brain injury (TBI) is a major cause of death and disability in children in both developed and developing nations. Children and adolescents suffer from TBI at a higher rate than the general population; however, research in this population lags behind research in adults. This may be due, in part, to the smaller number of investigators engaged in research with this population and may also be related to changes in safety laws and clinical practice that have altered length of hospital stays, treatment, and access to this population. Specific developmental issues also warrant attention in studies of children, and the ever-changing context of childhood and adolescence may require larger sample sizes than are commonly available to adequately address remaining questions related to TBI. The ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Pediatric Moderate-Severe TBI (msTBI) group aims to advance research in this area through global collaborative meta-analysis. In this paper we discuss important challenges in pediatric TBI research and opportunities that we believe the ENIGMA Pediatric msTBI group can provide to address them. We conclude with recommendations for future research in this field of study.

Association of Ventilation during Initial Trauma Resuscitation for Traumatic Brain Injury and Post-Traumatic Outcomes: A Systematic Review

2021 ◽  
pp. 1-6
Author(s):  
Mary Beth Howard ◽  
Nichole McCollum ◽  
Emily C. Alberto ◽  
Hannah Kotler ◽  
Mary E. Mottla ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Trauma Resuscitation ◽  
Cerebral Herniation ◽  
Full Text Review ◽  
Post Traumatic ◽  
Ventilation Strategies ◽  
End Tidal

Abstract Objectives: In the absence of evidence of acute cerebral herniation, normal ventilation is recommended for patients with traumatic brain injury (TBI). Despite this recommendation, ventilation strategies vary during the initial management of patients with TBI and may impact outcome. The goal of this systematic review was to define the best evidence-based practice of ventilation management during the initial resuscitation period. Methods: A literature search of PubMed, CINAHL, and SCOPUS identified studies from 2009 through 2019 addressing the effects of ventilation during the initial post-trauma resuscitation on patient outcomes. Results: The initial search yielded 899 articles, from which 13 were relevant and selected for full-text review. Six of the 13 articles met the inclusion criteria, all of which reported on patients with TBI. Either end-tidal carbon dioxide (ETCO2) or partial pressure carbon dioxide (PCO2) were the independent variables associated with mortality. Decreased rates of mortality were reported in patients with normal PCO2 or ETCO2. Conclusions: Normoventilation, as measured by ETCO2 or PCO2, is associated with decreased mortality in patients with TBI. Preventing hyperventilation or hypoventilation in patients with TBI during the early resuscitation phase could improve outcome after TBI.

Sign in / Sign up

Export Citation Format

Share Document