scholarly journals Use of Mannitol and Saline Solution in the management of ICP in patients with Traumatic Brain Injury: Evidence of superiority?

2021 ◽  
Author(s):  
Isaac Rêgo Purificação ◽  
Rodrigo Defensor Meira ◽  
Vitor Gabriel Dantas Costa
Keyword(s):  
Traumatic Brain Injury ◽  
Clinical Trials ◽  
Brain Injury ◽  
Saline Solution ◽  
Sodium Concentration ◽  
Laboratory Studies ◽  
Hemodynamic Changes ◽  
Hypertonic Saline Solution ◽  
Osmotic Effect ◽  
Mesh Terms

Background: Mannitol (MT) and Hypertonic Saline Solution (HSS) exert an osmotic effect by lowering Intracranial Pressure (ICP) in patients with Traumatic Brain Injury (TBI), but there are doubts as to which is more efficient. Objective: Analyze the use of MT and HSS in the management of ICP in patients suffering from TBI. Design and Settings: This is a literature review, produced by medical students from Bahia, Brazil. Methods: The evaluated studies were obtained in PubMed, with MeSH terms, published since 1988. The studies that did not correspond with the purpose of this review were excluded. Results: 34 of the 114 articles found, were selected. Observational and laboratory studies have shown an advantage in the use of SSH to reduce ICP and a longer duration of the effect in relation to MT. However, clinical trials and meta-analyzes do not show significant differences in relation to MT and SSH for reducing ICP, however they describe a slight preference for the use of SSH. As for side effects, MT mainly causes hemodynamic changes such as hypotension and SSH causes a significant increase in serum sodium concentration. Conclusion: Although there are benefits to both the use of TM and SSH, there is a preference to use SSH for the management of ICP in patients with TBI. The studies were not enough to show superiority in relation to these solutions and new Clinical Trials must be carried out.

scholarly journals Effect of volume replacement during combined experimental hemorrhagic shock and traumatic brain injury in prostanoids, brain pathology and pupil status

2015 ◽  
Vol 73 (6) ◽  
pp. 499-505 ◽  
Author(s):  
Fernando Campos Gomes Pinto ◽  
Matheus Fernandes de Oliveira ◽  
Ricardo Prist ◽  
Maurício Rocha e Silva ◽  
Luiz Fernando Ferraz da Silva ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Saline Solution ◽  
Venous Blood ◽  
Pathological Response ◽  
Control Group ◽  
Brain Pathology ◽  
Hypertonic Saline Solution ◽  
Pathological Evaluation ◽  
Experimental Hemorrhagic Shock

Traumatic brain injury (TBI) is the main cause of trauma-related deaths. Systemic hypotension and intracranial hypertension causes cerebral ischemia by altering metabolism of prostanoids. We describe prostanoid, pupilar and pathological response during resuscitation with hypertonic saline solution (HSS) in TBI.Method Fifteen dogs were randomized in three groups according to resuscitation after TBI (control group; lactated Ringer’s (LR) group and HSS group), with measurement of thromboxane, prostaglandin, macroscopic and microscopic pathological evaluation and pupil evaluation.Result Concentration of prostaglandin is greater in the cerebral venous blood than in plasma and the opposite happens with concentration of thromboxane. Pathology revealed edema in groups with the exception of group treated with HSS.Discussion and conclusion There is a balance between the concentrations of prostaglandin and thromboxane. HSS prevented the formation of cerebral edema macroscopically detectable. Pupillary reversal occurred earlier in HSS group than in LR group.

SURVEY IN SERUM ADH CONCENTRATION IN TRAUMATIC BRAIN INJURY PATIENTS

2014 ◽  
pp. 83-89
Author(s):  
Dung Ngo ◽  
Thi Nhan Nguyen ◽  
Khanh Hoang
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Osmotic Pressure ◽  
Negative Correlation ◽  
Closed Head Injury ◽  
Serum Levels ◽  
Sodium Concentration ◽  
Plasma Sodium ◽  
Plasma Sodium Concentration ◽  
Closed Head

Objective: Study on 106 patients with closed head injury, assessment of serum ADH concentration, correlation with Glasgow score, sodium and plasma osmotic pressure. Patients and methods: Patients with closed head injuries were diagnosed determined by computerized tomography, admitted to the Hue Central Hospital 72 hours ago. Results: (i) Serum concentration of ADH 42.21 ± 47.80 pg/ml. (ii) There is a negative correlation between serum levels of ADH with: (1) Glasgow point r = -0.323, p <0.01; (2) Plasma sodium concentration r = - 0.211, p > 0.05; (3) Plasma osmotic pressure r = - 0.218, p> 0.05. Conclusion: There is a negative correlation between serum levels of ADH with Glasgow scale, plasma sodium concentration and osmotic pressure in plasma. Key words: ADH traumatic brain injury.

scholarly journals Intraoperative hypothermia during vascular neurosurgical procedures

2009 ◽  
Vol 26 (5) ◽  
pp. E24 ◽  
Author(s):  
Raymond Choi ◽  
Robert H. Andres ◽  
Gary K. Steinberg ◽  
Raphael Guzman
Keyword(s):  
Traumatic Brain Injury ◽  
Clinical Trials ◽  
Brain Injury ◽  
Animal Models ◽  
Mild Hypothermia ◽  
Scientific Evidence ◽  
Neurosurgical Procedures ◽  
Ischemic Damage ◽  
Intraoperative Hypothermia ◽  
Improved Outcomes

Increasing evidence in animal models and clinical trials for stroke, hypoxic encephalopathy for children, and traumatic brain injury have shown that mild hypothermia may attenuate ischemic damage and improve neurological outcome. However, it is less clear if mild intraoperative hypothermia during vascular neurosurgical procedures results in improved outcomes for patients. This review examines the scientific evidence behind hypothermia as a treatment and discusses factors that may be important for the use of this adjuvant technique, including cooling temperature, duration of hypothermia, and rate of rewarming.

scholarly journals Assessment of White Matter Injury and Outcome in Severe Brain Trauma

2012 ◽  
Vol 117 (6) ◽  
pp. 1300-1310 ◽  
Author(s):  
Damien Galanaud ◽  
Vincent Perlbarg ◽  
Rajiv Gupta ◽  
Robert D. Stevens ◽  
Paola Sanchez ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Clinical Trials ◽  
Brain Injury ◽  
White Matter ◽  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Unfavorable Outcome ◽  
Operating Characteristic Curve

Background Existing methods to predict recovery after severe traumatic brain injury lack accuracy. The aim of this study is to determine the prognostic value of quantitative diffusion tensor imaging (DTI). Methods In a multicenter study, the authors prospectively enrolled 105 patients who remained comatose at least 7 days after traumatic brain injury. Patients underwent brain magnetic resonance imaging, including DTI in 20 preselected white matter tracts. Patients were evaluated at 1 yr with a modified Glasgow Outcome Scale. A composite DTI score was constructed for outcome prognostication on this training database and then validated on an independent database (n=38). DTI score was compared with the International Mission for Prognosis and Analysis of Clinical Trials Score. Results Using the DTI score for prediction of unfavorable outcome on the training database, the area under the receiver operating characteristic curve was 0.84 (95% CI: 0.75-0.91). The DTI score had a sensitivity of 64% and a specificity of 95% for the prediction of unfavorable outcome. On the validation-independent database, the area under the receiver operating characteristic curve was 0.80 (95% CI: 0.54-0.94). On the training database, reclassification methods showed significant improvement of classification accuracy (P &lt; 0.05) compared with the International Mission for Prognosis and Analysis of Clinical Trials score. Similar results were observed on the validation database. Conclusions White matter assessment with quantitative DTI increases the accuracy of long-term outcome prediction compared with the available clinical/radiographic prognostic score.

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