Journal of neurotrauma
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Journal of neurotrauma · Aug 2009
Randomized Controlled TrialResuscitation with hypertonic saline-dextran reduces serum biomarker levels and correlates with outcome in severe traumatic brain injury patients.
In the treatment of severe traumatic brain injury (TBI), the choice of fluid and osmotherapy is important. There are practical and theoretical advantages to the use of hypertonic saline. S100B, neuron-specific enolase (NSE), and myelin-basic protein (MBP) are commonly assessed biomarkers of brain injury with potential utility as diagnostic and prognostic indicators of outcome after TBI, but they have not previously been studied in the context of fluid resuscitation. ⋯ HSD-resuscitated patients with favorable outcomes exhibited the lowest serum S100B and NSE concentrations, while maximal levels were found in NS-treated patients with unfavorable outcomes. The lowest biomarker levels were seen in survivors resuscitated with HSD, while maximal levels were in NS-resuscitated patients with fatal outcome. Pre-hospital resuscitation with HSD is associated with a reduction in serum S100B, NSE, and MBP concentrations, which are correlated with better outcome after severe TBI.
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Journal of neurotrauma · Aug 2009
Prediction of outcome utilizing both physiological and biochemical parameters in severe head injury.
Traumatic brain injury is a major socioeconomic burden, and the use of statistical models to predict outcomes after head injury can help to allocate limited health resources. Earlier prediction models analyzing admission data have been used to achieve prediction accuracies of up to 80%. Our aim was to design statistical models utilizing a combination of both physiological and biochemical variables obtained from multimodal monitoring in the neurocritical care setting as a complement to earlier models. ⋯ The combined use of microdialysis variables and PbtO(2), in addition to ICP, MAP, and CPP was found have the best predictive accuracy. The use of physiological and biochemical variables based on a decision tree analysis model has shown to provide an improvement in predictive accuracy compared with other previous models. The potential application is for outcome prediction in the multivariate setting of advanced multimodality monitoring, and validates the use of multimodal monitoring in the neurocritical care setting to have a potential benefit in predicting outcomes of patients with severe head injury.
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Journal of neurotrauma · Aug 2009
Low-level blasts raise intracranial pressure and impair cognitive function in rats.
Brain injury after high-level blast has been established both clinically and experimentally. Less is known about the effects on the brain of exposure to low to moderate blast levels, such as those encountered by military personnel during the firing of weapons. This study investigates if exposure to occupational levels of low-level blasts affect intracranial pressure and cognitive performance. ⋯ After exposure to 10 or 30 kPa and re-testing 2 days later, the latency was increased by over 100%. The results show that exposure of rats to blast levels as low as 10 kPa affects both ICP and cognitive function. Though species differences do not allow direct extrapolation to humans, these findings do pose the question as to whether the thresholds for brain injury might be lower than those of other organs used to set training standards for blast exposure.
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Journal of neurotrauma · Aug 2009
Randomized Controlled TrialProstacyclin treatment in severe traumatic brain injury: a microdialysis and outcome study.
Prostacyclin (PGI(2)) is a potent vasodilator, inhibitor of leukocyte adhesion, and platelet aggregation. In trauma the balance between PGI(2) and thromboxane A(2) (TXA(2)) is shifted towards TXA(2). Externally provided PGI(2) would, from a theoretical and experimental point of view, improve the microcirculation in injured brain tissue. This study is a prospective consecutive double-blinded randomized study on the effect of PGI(2) versus placebo in severe traumatic brain injury (sTBI). All patients with sTBI were eligible. ⋯ verified sTBI, Glasgow Coma Score (GCS) at intubation and sedation of
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Journal of neurotrauma · Aug 2009
Effect of short periods of normobaric hyperoxia on local brain tissue oxygenation and cerebrospinal fluid oxidative stress markers in severe traumatic brain injury.
Preliminary evidence suggests local brain tissue oxygenation (PbtO(2)) values of