Articles: brain-injuries.
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Zhonghua Wei Zhong Bing Ji Jiu Yi Xue · Jun 2013
Randomized Controlled Trial Comparative Study[Effects of dexmedetomidine on sedation and β-endorphin in traumatic brain injury: a comparative study with propofol].
To compare the efficacy of dextraldexmede (DEX) and propofol on sedation and β-endorphin (β-EP) in patients with moderate and severe traumatic brain injury (TBI). ⋯ The sedation efficacy of DEX was superior to propofol in moderate and severe TBI, and was able to control excessive stress response after TBI better, and with more effect on blood pressure. Plasma β-EP was elevated during the early phase of brain injury by DEX, which was considered as its positive role in the regulation of early stress.
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Randomized Controlled Trial Comparative Study
Balanced versus chloride-rich solutions for fluid resuscitation in brain-injured patients: a randomized double-blind pilot study.
We sought to investigate whether the use of balanced solutions reduces the incidence of hyperchloraemic acidosis without increasing the risk for intracranial hypertension in patients with severe brain injury. ⋯ This study provides evidence that balanced solutions reduce the incidence of hyperchloraemic acidosis in brain-injured patients compared to saline solutions. Even if the study was not powered sufficiently for this endpoint, intracranial pressure did not appear different between groups.
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Journal of neurotrauma · Apr 2013
Randomized Controlled Trial Multicenter StudyAlbumin resuscitation for traumatic brain injury: is intracranial hypertension the cause of increased mortality?
Mortality is higher in patients with traumatic brain injury (TBI) resuscitated with albumin compared with saline, but the mechanism for increased mortality is unknown. In patients from the Saline vs. Albumin Fluid Evaluation (SAFE) study with TBI who underwent intracranial pressure (ICP) monitoring, interventional data were collected from randomization to day 14 to determine changes in ICP (primary outcome) and in therapies used to treat increased ICP. ⋯ There were statistically significant differences in the mean total daily doses of morphine (-0.42±0.07 vs. -0.66±0.0, p=0.0009), propofol (-0.45±0.11 vs. -0.76±0.11; p=0.034) and norepinephrine (-0.50±0.07 vs. -0.74±0.07) and in temperature (0.03±0.03 vs. 0.16±0.03; p=0.0014) between the albumin and saline groups when ICP monitoring ceased during the first week. The use of albumin for resuscitation in patients with severe TBI is associated with increased ICP during the first week. This is the most likely mechanism of increased mortality in these patients.
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Neurological research · Apr 2013
Randomized Controlled TrialVagus nerve stimulation to augment recovery from severe traumatic brain injury impeding consciousness: a prospective pilot clinical trial.
Traumatic brain injury (TBI) has high morbidity and mortality in both civilian and military populations. Blast and other mechanisms of TBI damage the brain by causing neurons to disconnect and atrophy. Such traumatic axonal injury can lead to persistent vegetative and minimally conscious states (VS and MCS), for which limited treatment options exist, including physical, occupational, speech, and cognitive therapies. More than 60 000 patients have received vagus nerve stimulation (VNS) for epilepsy and depression. In addition to decreased seizure frequency and severity, patients report enhanced mood, reduced daytime sleepiness independent of seizure control, increased slow wave sleep, and improved cognition, memory, and quality of life. Early stimulation of the vagus nerve accelerates the rate and extent of behavioral and cognitive recovery after fluid percussion brain injury in rats. ⋯ If this study demonstrates that VNS can safely and positively impact outcome, then a larger randomized prospective crossover trial will be proposed.
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J Trauma Acute Care Surg · Mar 2013
Randomized Controlled Trial Multicenter Study Comparative StudyA prospective multicenter comparison of levetiracetam versus phenytoin for early posttraumatic seizure prophylaxis.
Brain Trauma Foundation guidelines recommend seizure prophylaxis for preventing early posttraumatic seizure (PTS). Phenytoin (PHE) is commonly used. Despite a paucity of data in traumatic brain injury, levetiracetam (LEV) has been introduced as a potential replacement, which is more costly but does not require serum monitoring. The purpose of this study was to compare the efficacy of PHE with that of LEV for preventing early PTS. ⋯ Therapeutic study, level III.