Articles: brain-injuries.
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Critical care medicine · Sep 1998
Relationship of brain tissue PO2 to outcome after severe head injury.
To determine thresholds of brain tissue PO2 (PbtO2) that are critical for survival after severe head injury. ⋯ Analysis of the PbtO2 monitoring data suggested that the likelihood of death increased with increasing duration of time at or below a PbtO2 of 15 torr (2.0 kPa) or with the occurrence of any PbtO2 values of < or =6 torr (< or =0.8 kPa).
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The methods of monitoring the injured brain in intensive care have relied mainly on intermittent measurement. There is now increasing clinical interest in newer continuous forms of bedside monitoring that can help direct therapy earlier and more precisely. This article reviews continuous methods of monitoring cerebral perfusion, oxygenation, brain chemistry and function.
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Multicenter Study
Percutaneous computed tomographic-controlled ventriculostomy in severe traumatic brain injury.
Percutaneous computed tomographic (CT)-controlled ventriculostomy (PCV) was introduced for the monitoring of intracranial pressure in patients with severe traumatic brain injury who did not require simultaneous decompressive trepanation. ⋯ Distinct time savings are the major advantages of PCV, allowing exact catheter positioning even with very narrow ventricles.
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Am J Phys Med Rehabil · Sep 1998
Admission balance and outcomes of patients admitted for acute inpatient rehabilitation.
The objective of the study contained herein was to evaluate the clinical use of the Berg Balance Scale in a heterogeneous acute inpatient rehabilitation population and to assess the relationship between balance scores at admission and rehabilitation outcomes, including functional gain and length of stay. This was a prospective study of 45 patients with diagnoses including stroke (n = 15), traumatic brain injury (n = 19), and other impairments (n = 11) who were admitted for acute inpatient rehabilitation. Functional ability was evaluated with the Functional Independence Measure (FIM) instrument, and balance was measured using the 14-item Berg Balance Scale. ⋯ Balance scores collected at admission to inpatient rehabilitation, in whole and in part, were shown to account for moderate amounts of variation in length of stay and the FIM efficiency score. For several of the rehabilitation outcomes, balance scores at admission accounted for more variation than scores on the FIM instrument. These findings suggest that routine assessment of balance at admission to inpatient rehabilitation may enhance the ability to predict rehabilitation outcomes beyond that provided by assessment of functional status alone.
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Mild-to-moderate reductions in local cerebral blood flow (ICBF) have been reported to occur in rats after moderate (1.7-2.2 atm) fluid percussion brain injury. The purpose of this study was to determine whether evidence for severe ischemia (i.e., mean ICBF < 0.25 ml/g/min) could be demonstrated after severe brain injury. In addition, patterns of indium-labeled platelet accumulation and histopathological outcome were correlated with the hemodynamic alterations. ⋯ These data indicate that multiple cerebrovascular abnormalities, including subarachnoid hemorrhage, focal platelet accumulation, and severe ischemia, are important early events in the pathogenesis of cortical contusion formation after TBI. Injury severity is expected to be a critical factor in determining what therapeutic strategies are attempted in the clinical setting.