Articles: brain-injuries.
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Observational Study
Effect of nursing care based on goal-oriented mind mapping model on the prognosis of patients with severe brain injury.
The objective of this study was to observe the effect of nursing care based on goal-oriented mind-mapping on the prognosis of patients with severe brain injury. Clinical data of 116 patients with severe brain injury admitted to Qinghe County Central Hospital between March 2021 and August 2023 were retrospectively analyzed. Based on the nursing mode the patients received, they were divided into an Observation group (n = 58, patients received nursing based on the goal-oriented mind mapping mode) and a Control group (n = 58, patients received routine care). ⋯ The total incidence of complications in the Observation group was lower than that in the Control group (P < .05). After intervention, neurological function, cerebral oxygen metabolism indicators, and quality of life of the 2 groups improved significantly compared with those before the intervention; furthermore, the neurological function and cerebral oxygen metabolism indexes of the Observation group were better than those of the Control group (P < .05). The nursing care based on goal-oriented mind-mapping model for patients with severe brain injury can effectively shorten the length of hospital stay, reduce the occurrence of prognostic complications, and improve the recovery of neurological and limb motor functions, and ultimately achieve the goal of improving the quality of life.
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Administering intravenous fluids is a common therapy for critically ill patients. Isotonic crystalloid solutions, such as saline or balanced solutions, are frequently used for intravenous fluid therapy. ⋯ Although the broad eligibility criteria of these RCTs suggest applicability to neurocritical care patients, it is important to discuss whether using balanced crystalloids, as opposed to saline, would benefit patients who primarily have neurological disorders or diseases. This review considers the relevance of this question, weighs the pros and cons of the two fluid types, examines available data, and anticipates results from ongoing RCTs to guide clinicians in selecting the optimal fluid for patients with brain injury.
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Today, invasive intracranial pressure (ICP) measurement remains the standard, but its invasiveness limits availability. Here, we evaluate a novel ultrasound-based optic nerve sheath parameter called the deformability index (DI) and its ability to assess ICP noninvasively. Furthermore, we ask whether combining DI with optic nerve sheath diameter (ONSD), a more established parameter, results in increased diagnostic ability, as compared to using ONSD alone. ⋯ Combining ONSD with DI holds the potential of increasing the ability of optic nerve sheath parameters in the noninvasive assessment of ICP, compared to using ONSD alone, and further study of DI is warranted.
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Traumatic brain injury (TBI) presents complex clinical challenges, requiring a nuanced understanding of its pathophysiology and current management principles to improve patient outcomes. Anesthetists play a critical role in care and need to stay updated with recent evidence and trends to ensure high-quality treatment. The Brain Trauma Foundation Guidelines, last updated in 2016, have shown moderate adherence, and much of the current management relies on expert opinions. This literature review synthesizes the current evidence and provides insights into the role of anesthetists in TBI management. ⋯ Anesthesia for TBI patients requires a comprehensive approach that balances anesthetic goals with the unique pathophysiological factors of brain injury. Despite recent research expanding our understanding, challenges remain in standardizing protocols and addressing individual patient response variability. Adherence to established management principles, personalized approaches, and ongoing research is crucial for improving the outcomes.
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Journal of neurotrauma · Oct 2024
Randomized Controlled Trial Multicenter StudyPredicting Progression of Intracranial Hemorrhage in the Prehospital TXA for TBI Trial.
Progression of intracranial hemorrhage is a common, potentially devastating complication after moderate/severe traumatic brain injury (TBI). Clinicians have few tools to predict which patients with traumatic intracranial hemorrhage on their initial head computed tomography (hCT) scan will progress. The objective of this investigation was to identify clinical, imaging, and/or protein biomarkers associated with progression of intracranial hemorrhage (PICH) after moderate/severe TBI and to create an accurate predictive model of PICH based on clinical features available at presentation. ⋯ Models composed of machine-selected features performed better than models composed of expert-selected variables (reaching an average of 77% accuracy, AUC = 0.78 versus AUC = 0.68 for the expert-selected variables). Predictive models utilizing variables measured at admission can accurately predict PICH, confirmed by the 6-hour follow-up hCT. Our best-performing models must now be externally validated in a separate cohort of TBI patients with low GCS and initial hCT positive for hemorrhage.