Articles: brain-injuries.
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Randomized Controlled Trial
Slope of the intracranial pressure waveform after traumatic brain injury.
The measurement and treatment of ICP within the management of TBI generally focuses on keeping the mean ICP to less than 20 mm Hg. More sophisticated analysis of the intracranial pressure waveform has yielded important relationships, but those methods have not gained widespread use. Prior analysis of the slope of the ICP waveform during inspiration and expiration in patients with hydrocephalus has provided valuable information that has never been applied to patients with TBI. This study used digital methods to examine ICP and the slope of the ICP waveform in relation to the respiratory cycle in subjects with TBI. ⋯ Greater systolic ICP waveform slope during inspiration has not been described previously after TBI and is consistent with prior observations in subjects with hydrocephalus. The strong correlation between ICP slope and simultaneous mean ICP suggests that increasing ICP slope might indicate loss of intracranial compliance after TBI.
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Randomized Controlled Trial Multicenter Study
Hypothermia therapy after traumatic brain injury in children.
Hypothermia therapy improves survival and the neurologic outcome in animal models of traumatic brain injury. However, the effect of hypothermia therapy on the neurologic outcome and mortality among children who have severe traumatic brain injury is unknown. ⋯ In children with severe traumatic brain injury, hypothermia therapy that is initiated within 8 hours after injury and continued for 24 hours does not improve the neurologic outcome and may increase mortality. (Current Controlled Trials number, ISRCTN77393684 [controlled-trials.com].).
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Randomized Controlled Trial
[Effect of transcutaneous acupoint electrical stimulation on blood bioactive compounds involving cerebral injury during craniotomy].
To observe the effect of transcutaneous acupoint electrical stimulation (TAES) on plasma ET, CGRP and serum IL-6, S100beta during craniotomy. ⋯ TAES can regulate plasma CGRP/ET and serum IL-6, lower serum S100beta level, which may contribute to its effect in relieving craniotomy-induced brain injury.
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Randomized Controlled Trial Comparative Study
Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial.
Experimental research has demonstrated that the level of neuroprotection conferred by the various barbiturates is not equal. Until now no controlled studies have been conducted to compare their effectiveness, even though the Brain Trauma Foundation Guidelines recommend that such studies be undertaken. The objectives of the present study were to assess the effectiveness of pentobarbital and thiopental in terms of controlling refractory intracranial hypertension in patients with severe traumatic brain injury, and to evaluate the adverse effects of treatment. ⋯ Thiopental appeared to be more effective than pentobarbital in controlling intracranial hypertension refractory to first-tier measures. These findings should be interpreted with caution because of the imbalance in cranial tomography characteristics and the different dosages employed in the two arms of the study. The incidence of adverse effects was similar in both groups.
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Bmc Med Res Methodol · Jan 2008
Randomized Controlled TrialUse of the Oxford Handicap Scale at hospital discharge to predict Glasgow Outcome Scale at 6 months in patients with traumatic brain injury.
Traumatic brain injury (TBI) is an important cause of acquired disability. In evaluating the effectiveness of clinical interventions for TBI it is important to measure disability accurately. The Glasgow Outcome Scale (GOS) is the most widely used outcome measure in randomised controlled trials (RCTs) in TBI patients. However GOS measurement is generally collected at 6 months after discharge when loss to follow up could have occurred. The objectives of this study were to evaluate the association and predictive validity between a simple disability scale at hospital discharge, the Oxford Handicap Scale (OHS), and the GOS at 6 months among TBI patients. ⋯ We have shown that the OHS, a simple disability scale available at hospital discharge can predict disability accurately, according to the GOS, at 6 months. OHS could be used to improve the design and analysis of clinical trials in TBI patients and may also provide a valuable clinical tool for physicians to improve communication with patients and relatives when assessing a patient's prognosis at hospital discharge.