Severe head injury: control of physiological variables, organ failure and complications in the intensive care unit (original) (raw)
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Intensive Care Medicine, 1994
Objective: To study the additional contribution of non-neurologic disturbances in acute physiology and chronic health to the prediction of intensive care outcome in patients with head injury or non-traumatic intracranial haemorrhage. Design: A nationwide study in Finland with prospectively collected data on all adult patients admitted to intensive care after head trauma or non-traumatic intracranial haemorrhage during a 14-month period. Two-thirds of the patients were randomly selected to derive predictive models, and the remaining one third constituted the validation sample. Setting: A total of 25 medical and surgical ICUs in Finland (13 in tertiary referral centers). Patients: 901 consecutive adult patients with head injury or non-traumatic intracranial haemorrhage. Measurements and results." Variables of the APACHE II including Glasgow Coma Score were collected at the time of ICU admission. Two predictive models were created to explain hospital mortality. The addition of variables describing acute physiology to a predictive model consisting of Glasgow Coma Score, age, diagnosis of head injury and the type of ICU admission did not increase its performance in discriminating between survivors and nonsurvivors, but the calibration accuracy of the predictive model especially at the high ranges of risk was improved. Conclusions: The non-neurologic disturbances in acute physiology have prognostic significance in the prediction of intensive care outcome in patients with head injury or non-traumatic intracerebral haemorrhage. The created predictive model may supplement clinical judgement of this patient group.
Critical care management of severe head injury
Anaesthesia & Intensive Care Medicine, 2014
Severe traumatic brain injury (TBI) is a significant cause of morbidity and mortality. The intensive care management of TBI requires a coordinated and comprehensive approach to treatment, including strategies to prevent secondary brain injury by avoidance of systemic physiological disturbances, such as hypotension, hypoxaemia, hypoglycaemia, hyperglycaemia and hyperthermia, and maintenance of adequate cerebral perfusion and oxygenation. There have been marked improvements in the management of patients with severe TBI over the last two decades, and treatment advances in the pre-hospital setting and emergency department have recently extended into the intensive care unit. The management of head injury has undergone extensive revision as evidence accumulates that established practices are not as effective or innocuous as previously believed. Management protocols have evolved with international consensus, providing guidelines that assist clinicians in delivering optimal care. Improved diagnostic and monitoring modalities are improving the understanding of the pathophysiology of head injury and allowing the delivery of individualised therapy.
Hyperglycemia: A Predictor of Death in Severe Head Injury Patients
Clinical Medicine Insights: Endocrinology and Diabetes, 2016
Objectives Management of hyperglycemia during an acute sickness in adults is accompanied by improved outcomes. We have designed a prospective study with meticulous attention to exclude all diabetes patients by checking hemoglobin A1c (HbA1c or glycated hemoglobin) to avoid the ill-effects of hyperglycemia in patients with traumatic head injury admitted to the intensive care unit (ICU). Methods This prospective study included adults with traumatic primary brain injury with a Glasgow coma score of ≥8 necessitating mechanical ventilation treated in the period 2012–2015. After screening 311 patients, 220 were included in the study. Both blood glucose and HbA1c levels of all the patients at admission, as well as blood glucose level after 72 hours, were obtained from the records. The patients were later grouped based on their admission blood glucose levels (<200 mg/dL or ≤200 mg/dL). Injury severity score (ISS) was documented for every patient. As a final point, the outcomes were deter...
Ventilatory status early after head injury
Annals of Emergency Medicine, 1983
The ventilatory status of patients within the first few hours following head injury has not been well established. We prospectively studied 63 patients who presented to an urban trauma center with varying severity of head injury to determine whether any trend toward hypo-or hyperventilation existed within the first two hours following injury. Arterial blood gas analysis done on emergency presentation showed that 14 patients with severe head injury (Glasgow coma scale ~ 4) had mean pH values of 7.29 and mean PaC02 of 41.86 torr. IWenty patients categorized as moderate head injury (GCS = 5-11) had mean pH values of 7.38 with a mean PaC02 of 34.1 torr. T~venty-nine patients with GCS >I 12 had mean pH and PaC02 values of 7.4 and 31.8 torr, respectively. These differences in pH and PaC02 were statistically significant between the GCS groups with mild and severe head injury (P ~ .01 pH), (P = .05 PC02), and could not be explained on the basis of hypoxemia, blood alcohol level, hypotension, or associated chest injury. It is concluded that patients with severe craniocerebral trauma show an early trend toward hypercapnea and acidosis. Immediate control of airway and assisted ventilation is necessary in order to reduce PaC02 to optimal levels in patients with severe head injury. [Vicario SL Coleman R, Cooper MA, Thomas DM: Ventilatory status early after head injury. Ann
Improved Hemodynamic Status of Head Injured Patients in the Emergency Unit (ER): Literature Review
Jurnal Ilmiah Ilmu Keperawatan Indonesia, 2021
Background: Head injury is a serious problem that can lead to death and even death. Handling of head injuries starts from protecting the brain with blood flow to the brain so that hypoxia or brain ischemia does not occur. Hemodynamics is the result of measuring systolic and diastolic blood pressure, pulse rate, and respiratory rate. Objectives: This literature review aims to find out what interventions can be done when there is an increase in hemodynamic status in head injury patients Methods: This database search was conducted by searching on google scholars with the keywords head injury, hemodynamics. The inclusion criteria of this literature review are articles that were researched within the last 5 years with the year published 2015-2020, full text, using the Indonesian language, the article that used is the article. Results: Interventions that can be done when there is an increase in hemodynamic status in head injury patients are giving oxygen and increasing 30o, giving oxygen ...
Annals of Emergency Medicine, 1983
Objective: Intracranial hypertension after severe head injury is associated with case fatality, but there is no sound evidence that monitoring of intracranial pressure (ICP) and targeted management of cerebral perfusion pressure (CPP) improve outcome, despite widespread recommendation by experts in the field. The purpose was to determine the effect of ICP/CPP-targeted intensive care on functional outcome and therapy intensity levels after severe head injury.
Ulusal Travma Ve Acil Cerrahi Dergisi Turkish Journal of Trauma Emergency Surgery Tjtes, 2009
BACKGROUND: The Glasgow Coma Scale (GCS) is popular, simple, and reliable, and provides information about the level of consciousness in trauma patients. Nevertheless, the necessity of using a more complex system than GCS has been questioned recently. The revised Acute Physiology and Chronic Health Evaluation system (APACHE II) is a physiologically based system including 12 physiological variables, and it also includes GCS. In addition, it is thought to be superior to GCS due to recognition of increasing age and significant chronic health problems, which adversely affect mortality.METHODS: This retrospective study included 266 patients (195 males, 71 females; mean age 60.5; range 14 to 87 years) with head injury associated with systemic trauma in 2003 and 2004.RESULTS: Mortality increased in the elderly group (p<0.001). Mean survival score in APACHE II was 38.0 and death score was 68.7 (p<0.001); these values in GCS were 10.4 and 6.3, respectively (p<0.001). APACHE II at the cut-off point was better than GCS in the prediction of death and survival in patients (p<0.01). The area under the receiver operating characteristic curve for sensitivity and specificity was larger in APACHE II (0.892+/-0.028) than GCS (0.862+/-0.029).CONCLUSION: For the assessment of mortality, the GCS score still provides simple, less-time consuming and effective information concerning head injury patients, especially in emergencies; however, for the prediction of mortality in multitrauma patients, APACHE II is superior to GCS since it includes the main physiologic parameters of patients.
Journal of Neurosurgical Anesthesiology, 1999
Objectives-To assess the eVectiveness of interventions routinely used in the intensive care management of severe head injury, specifically, the eVectiveness of hyperventilation, mannitol, CSF drainage, barbiturates, and corticosteroids. Methods-Systematic review of all unconfounded randomised trials, published or unpublished, that were available by August 1996. Results-None of the interventions has been reliably shown to reduce death or disability after severe head injury. One trial of hyperventilation was identified of 77 participants. The relative risk for death was 0.73 (95% confidence interval (95% CI) 0.36-1.49), and for death or disability it was 1.14 (95% CI 0.82-1.58). One trial of mannitol was identified of 41 participants. The relative risk for death was 1.75 (95% CI 0.48-6.38), no data were available for disability. No randomised trials of CSF drainage were identified. Two randomised trials of barbiturate therapy were identified, including 126 participants. The pooled relative risk for death was 1.12 (95% CI 0.81-1.54). Disability data were available for one trial. The relative risk for death or disability was 0.96 (95% CI 0.62-1.49). Thirteen randomised trials of corticosteroids were identified, comprising 2073 participants. The pooled relative risk for death was 0.95 (0.84 to 1.07) and for death or disability it was 1.01 (95% CI 0.91 to 1.11). On the basis of the currently available randomised evidence, for every intervention studied it is impossible to refute either a moderate increase or a moderate decrease in the risk of death or disability. Conclusion-Existing trials have been too small to support or refute the existence of a real benefit from using hyperventilation, mannitol, CSF drainage, barbiturates, or corticosteroids. Further large scale randomised trials of these interventions are required. (J Neurol Neurosurg Psychiatry 1998;65:729-733) Keywords: head injuries; systematic review; metaanalysis; randomised controlled trials World wide, several million people, mostly children and young adults, are treated each