Articles: injury.
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Curr Opin Anaesthesiol · Feb 2025
Towards optimization in the use of hemostatic agents and blood products in the early treatment of patients with traumatic brain injury (TBI).
The treatment of patients with traumatic brain injury (TBI) with subsequently evolving hemostatic failure and hemorrhagic lesion progression remains challenging. New studies highlight windows of opportunity for treatment optimization. ⋯ Mortality in TBI with subsequent evolving hemostatic failure can be reduced through treatment optimization delivering early prehospital high-dose tranexamic acid and in-hospital goal-directed treatment algorithms to timely correct coagulopathy and restore hemostasis.
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Pulmonary capillary blood volume is a major determinant of lung gas transport efficiency, and also potentially related to ventilator-induced lung injury. Yet, knowledge on how lung expansion influences pulmonary blood volume in injured lungs is scant. We hypothesize that lung expansion produced by positive end-expiratory pressure (PEEP) modulates the global and regional spatial distribution of pulmonary blood volume. ⋯ During low-volume mechanical ventilation and systemic endotoxemia, lung blood volume is markedly heterogeneously distributed, and modulated by PEEP. Nondependent regions are susceptible to low blood volume and capillary closure. Recruitment of pulmonary vascular blood volume with gas volume is nonlinear, limited at intermediate PEEP indicating its advantage to spatial distribution of blood volume.
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This review aims to summarize recent developments for the management of severe traumatic brain injury (TBI) in the ICU. Recent advancements in TBI ICU management emphasize a progression toward more multimodal approaches and mitigating secondary brain injury by increased focus on careful systemic management. ⋯ ICP monitoring remains a key component of severe TBI management in ICU. Emerging evidence is slowly changing and improving intensive care and patient outcomes and include both brain-targeted therapies and careful systemic intensive care management.