Journal of neurotrauma
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Journal of neurotrauma · Jun 2000
Review Practice Guideline GuidelineThe Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Glasgow coma scale score.
When considering the use of the initial GCS for prognosis, the two most important problems are the reliability of the initial measurement, and its lack of precision for prediction of a good outcome if the initial GCS is low. If the initial GCS is reliably obtained and not tainted by prehospital medications or intubation, approximately 20% of the patients with the worst initial GCS will survive and 8-10% will have a functional survival (GOS 4-5).
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Journal of neurotrauma · Jun 2000
Review Practice Guideline GuidelineThe Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Pupillary diameter and light reflex.
The pupillary diameter and the pupilloconstrictor light reflex are the two parameters that have been studied extensively in relation to prognosis. Accurate measurement of pupil diameter or the constrictor response or the duration of the response has not been performed in studies on traumatic brain-injured individuals--for lack of a standardized measuring procedure. The following is recommended: 1. ⋯ Hypotension and hypoxia should be corrected before assessing pupils for prognosis. 7. Direct orbital trauma should be excluded. 8. Pupils should be reassessed after surgical evacuation of intracranial hematomas.
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Journal of neurotrauma · Jun 2000
Review Practice Guideline GuidelineThe Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Intracranial pressure treatment threshold.
An absolute ICP threshold that is uniformly applicable is unlikely to exist. Current data, however, support 20-25 mm Hg as an upper threshold above which treatment to lower ICP should generally be initiated.
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Journal of neurotrauma · Jun 2000
Review Practice Guideline GuidelineThe Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Nutrition.
Data show that starved head-injured patients lose sufficient nitrogen to reduce weight by 15% per week. Class II data show that 100-140% replacement of resting metabolism expenditure with 15-20% nitrogen calories reduces nitrogen loss. Data in non-head injured patients show that a 30% weight loss increased mortality rate. ⋯ The data strongly support feeding at least by the end of the first week. It has not been established that any method of feeding is better than another or that early feeding prior to 7 days improves outcome. Based on the level of nitrogen wasting documented in head-injured patients and the nitrogen sparing effect of feeding, it is a guideline that full nutritional replacement be instituted by day 7.
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Journal of neurotrauma · Jun 2000
Review Practice Guideline GuidelineThe Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Use of barbiturates in the control of intracranial hypertension.
High-dose barbiturate therapy is efficacious in lowering ICP and decreasing mortality in the setting of uncontrollable ICP refractory to all other conventional medical and surgical ICP-lowering treatments. Utilization of barbiturates for the prophylactic treatment of ICP is not indicated. The potential complications attendant on this form of therapy mandate that its use be limited to critical care providers and that appropriate systemic monitoring be undertaken to avoid or treat any hemodynamic instability. When barbiturate coma is utilized, consideration should also be given to monitoring arteriovenous oxygen saturation as some patients treated in this fashion may develop oligemic cerebral hypoxia.