Articles: traumatic-brain-injuries.
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Molecular neurobiology · Aug 2016
ReviewThe Role of Nitric Oxide and Sympathetic Control in Cerebral Autoregulation in the Setting of Subarachnoid Hemorrhage and Traumatic Brain Injury.
Cerebral autoregulation is defined as the mechanism by which constant cerebral blood flow is maintained despite changes of arterial blood pressure, and arterial blood pressure represents the principle aspect of cerebral autoregulation. The impairment of cerebral autoregulation is reported to be involved in several diseases. However, the concept, mechanisms, and pathological dysfunction of cerebral autoregulation are beyond full comprehension. ⋯ Additionally, impaired cerebral autoregulation following subarachnoid hemorrhage and traumatic brain injury has been proven by several descriptive studies, although without corresponding explanations. As the most important mechanisms of cerebral autoregulation, the changes of nitric oxide and sympathetic stimulation play significant roles in these insults. Therefore, the in-depth researches of nitric oxide and sympathetic nerve in cerebral autoregulation may help to develop new therapeutic targets.
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OBJECTIVE Concerns about mild traumatic brain injury (mTBI) have increased in recent years, and neurosurgical consultation is often requested for patients with radiographic abnormalities or clinical findings suspicious for mTBI. However, to the authors' knowledge, no study has used the Acute Concussion Evaluation (ACE) tool to systematically evaluate the evolution of symptoms in patients with mTBI during neurosurgical follow-up. The goal in this study was to evaluate symptom progression in pediatric patients referred for neurosurgical consultation by using the ACE, as endorsed by the Centers for Disease Control and Prevention. ⋯ Patients with positive head CT findings required longer follow-up: these patients needed 14.59 weeks, versus 7.87 weeks of follow-up in patients with negative findings on head CT scans (p < 0.05). CONCLUSIONS The data suggest that patients with mTBI, particularly those with developmental and/or psychiatric comorbidities and concurrent cerebral or extracranial injury, often report symptoms for several weeks after their initial injury. Serial ACE assessment permits systematic identification of patients who are experiencing continued symptoms, leading to appropriate patient management and referral.
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Journal of anesthesia · Aug 2016
Preoperative serum lactate cannot predict in-hospital mortality after decompressive craniectomy in traumatic brain injury.
Despite the utility of serum lactate for predicting clinical courses, little information is available on the topic after decompressive craniectomy. This study was conducted to determine the ability of perioperative serum lactate levels to predict in-hospital mortality in traumatic brain-injury patients who received emergency or urgent decompressive craniectomy. ⋯ Preoperative lactate level is not an independent predictor of in-hospital mortality after decompressive craniectomy in traumatic brain-injury patients.
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Journal of critical care · Aug 2016
Safety of peripheral administration of phenylephrine in a neurologic intensive care unit: A pilot study.
Integral to the management of the neurocritically injured patient are the prevention and treatment of hypotension, maintenance of cerebral perfusion pressure, and occasionally blood pressure augmentation. When adequate volume resuscitation fails to meet perfusion needs, vasopressors are often used to restore end-organ perfusion. This has historically necessitated central venous access given well-documented incidence of extravasation injuries associated with peripheral administration of vasopressors. ⋯ We were able to administer peripheral phenylephrine, up to a dose of 2 μg/(kg min), for an average of 14.29hours (1-54.3) in 20 patients with only 1 possible minor complication and no major complications. This was achieved by adding additional safety measures in our computerized physician order entry system and additional nurse-driven safety protocols. Thus, with careful monitoring and safety precautions, peripheral administration of phenylephrine at an optimized concentration appears to have an acceptable safety profile for use in the neurocritical care unit up to a mean infusion time of 14hours.
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For critically ill adult patients with acute traumatic brain injury (TBI), we assessed the clinical and cost-effectiveness of: (a) Management in dedicated neurocritical care units versus combined neuro/general critical care units within neuroscience centres. (b) 'Early' transfer to a neuroscience centre versus 'no or late' transfer for those who present at a non-neuroscience centre. ⋯ For critically ill adult patients with acute TBI, within neuroscience centres management in dedicated neurocritical care units versus combined neuro/general units led to improved QoL and higher costs, on average, but these differences were not statistically significant. This study finds that 'early' transfer to a neuroscience centre is associated with reduced mortality, improvement in QOL and is cost-effective.