Articles: brain-injuries.
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In an attempt to assess admission Glasgow Coma Scale (GCS) scores and other radiographic variables after penetrating craniocerebral injury in relationship to outcome, the author evaluated a series of 294 patients with penetrating injuries who presented with a GCS score of 6 to 15 over a 6-year period. Entrance criteria required a replicable neurological examination that was not altered by the presence of hypotension, drugs/toxins, or systemic injury. All patients underwent surgical intervention and aggressive perioperative management, including resuscitative protocols, in the neurosurgical intensive care unit. ⋯ No significant relationships between operative intervention and survival were found in patients with admission GCS scores of 9 to 12 and 13 to 15. A significant relationship between operative intervention and morbidity (p < or = 0.01) was also demonstrated in patients with an admission GCS score of 12 to 15. No significant relationships between operative intervention and morbidity were found in patients with an admission GCS score of 6 to 8 and 9 to 12.
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Zentralbl. Neurochir. · Jan 2000
Comparative StudyNear-infrared spectroscopy--not useful to monitor cerebral oxygenation after severe brain injury.
Since its development more than twenty years ago, non-invasive near-infrared-spectroscopy (NIRS) has been widely used to monitor cerebral oxygenation. Despite of its growing number of users, the diagnostic value of near-infrared spectroscopy still remains unclear, especially in case of acute brain injury and long-term neuromonitoring, necessary during intensive care therapy. To evaluate quality and sensitivity of NIRS measurements compared to invasive ICP-, CPP- and regional brain tissue--pO2 (p(ti)O2) monitoring, 31 patients, suffering from severe brain injury due to subarachnoid hemorrhage or severe head injury, were studied. ⋯ Only induced hyperoxia (FiO2 = 1.0) revealed a significant correlation between both parameters (r = 0.67, p < 0.01). Lower or no correlation was found after changing paCO2 and administration of mannitol. The high failure rate and the limited sensitivity does not make the clinical use of near-infrared spectroscopy suitable as a part of neuromonitoring after acute brain injury at the present time.
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Journal of neurosurgery · Jan 2000
No reduction in cerebral metabolism as a result of early moderate hyperventilation following severe traumatic brain injury.
Hyperventilation has been used for many years in the management of patients with traumatic brain injury (TBI). Concern has been raised that hyperventilation could lead to cerebral ischemia; these concerns have been magnified by reports of reduced cerebral blood flow (CBF) early after severe TBI. The authors tested the hypothesis that moderate hyperventilation induced early after TBI would not produce a reduction in CBF severe enough to cause cerebral energy failure (CBF that is insufficient to meet metabolic needs). ⋯ The authors conclude that early, brief, moderate hyperventilation does not impair global cerebral metabolism in patients with severe TBI and, thus, is unlikely to cause further neurological injury. Additional studies are needed to assess focal changes, the effects of more severe hyperventilation, and the effects of hyperventilation in the setting of increased ICP.
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Low body temperature is induced by surface cooling to reduce metabolic demands in patients with severe cerebral injury. Shivering, which increases energy expenditure, is a common effect of surface cooling. The aim of this pilot study was to investigate whether increased gradient between the set point and peripheral temperature is related to shivering and whether modifying the loss of body heat during surface cooling decreases the frequency of shivering. ⋯ There was a significant association between increased temperature gradient and shivering (P < 0.01). Modifying the rate of heat loss decreased the temperature gradient (P < 0.001). By simultaneously measuring the tympanic and tip toe temperatures it may be possible to detect shivering earlier and decrease its frequency by modifying the loss of body heat during surface cooling.
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Critical care medicine · Jan 2000
Comparative StudyChanges in the management of severe traumatic brain injury: 1991-1997.
To survey the management of head-injured patients in 1997 and to identify differences compared with a survey conducted in 1991. ⋯ There have been significant changes in the acute management of patients with severe TBI since 1991. Current practices more closely reflect the recommendations of evidence-based guidelines.