scholarly journals Intensive Care in Traumatic Brain Injury Including Multi-Modal Monitoring and Neuroprotection

2019 ◽  
Vol 7 (3) ◽  
pp. 37 ◽  
Author(s):  
Reto A. Stocker
Keyword(s):  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Brain Injuries ◽  
Early Time ◽  
Severe Form ◽  
Secondary Brain Injury ◽  
Age Related ◽  
Glascow Coma Scale ◽  
Brain Insults

Moderate to severe traumatic brain injuries (TBI) require treatment in an intensive care unit (ICU) in close collaboration of a multidisciplinary team consisting of different medical specialists such as intensivists, neurosurgeons, neurologists, as well as ICU nurses, physiotherapists, and ergo-/logotherapists. Major goals include all measurements to prevent secondary brain injury due to secondary brain insults and to optimize frame conditions for recovery and early rehabilitation. The distinction between moderate and severe is frequently done based on the Glascow Coma Scale and therefore often is just a snapshot at the early time of assessment. Due to its pathophysiological pathways, an initially as moderate classified TBI may need the same sophisticated surveillance, monitoring, and treatment as a severe form or might even progress to a severe and difficult to treat affection. As traumatic brain injury is rather a syndrome comprising a range of different affections to the brain and as, e.g., age-related comorbidities and treatments additionally may have a great impact, individual and tailored treatment approaches based on monitoring and findings in imaging and respecting pre-injury comorbidities and their therapies are warranted.

Judgments of Critical Care Nurses About Risk for Secondary Brain Injury

2010 ◽  
Vol 19 (3) ◽  
pp. 250-260 ◽  
Author(s):  
Molly McNett ◽  
Margaret Doheny ◽  
Carol A. Sedlak ◽  
Ruth Ludwick
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Oxygen Saturation ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Secondary Brain Injury ◽  
Intensive Care Unit Nurses

Background Interdisciplinary care for patients with traumatic brain injury focuses on treating the primary brain injury and limiting further brain damage from secondary injury. Intensive care unit nurses have an integral role in preventing secondary brain injury; however, little is known about factors that influence nurses’ judgments about risk for secondary brain injury. Objective To investigate which physiological and situational variables influence judgments of intensive care unit nurses about patients’ risk for secondary brain injury, management solely with nursing interventions, and management by consulting another member of the health care team. Methods A multiple segment factorial survey design was used. Vignettes reflecting the complexity of real-life scenarios were randomly generated by using different values of each independent variable. Surveys containing the vignettes were sent to nurses at 2 level I trauma centers. Multiple regression was used to determine which variables influenced judgments about secondary brain injury. Results Judgments about risk for secondary brain injury were influenced by a patient’s oxygen saturation, intracranial pressure, cerebral perfusion pressure, mechanism of injury, and primary diagnosis, as well as by nursing shift. Judgments about interventions were influenced by a patient’s oxygen saturation, intracranial pressure, and cerebral perfusion pressure and by nursing shift. The initial judgments made by nurses were the most significant variable predictive of follow-up judgments. Conclusions Nurses need standardized, evidence-based content for management of secondary brain injury in critically ill patients with traumatic brain injury.

scholarly journals Analysis of Neuron Specific Enolase Serum Levels in Traumatic Brain Injury

2021 ◽  
Vol 5 (4) ◽  
pp. 1218-1222
Author(s):  
Yuliarni Syafrita ◽  
Nora Fitri
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Injuries ◽  
Neuron Specific Enolase ◽  
Serum Levels ◽  
Pathological Process ◽  
P Value ◽  
Secondary Brain Injury ◽  
Post Injury ◽  
The Brain

Background : Traumatic brain injury is still the main cause of death and disability in productive age. Assessment the level of consciousness and imaging examinations after a brain injury can not always describe the severity of damage in the brain, this is because the pathological process is still ongoing due to secondary brain injury. Therefore, it is necessary to examine biomarkers that can describe the severity of the pathological process that occurs. The purpose of this study was to assess serum neuron-specific enolase (NSE) levels and their relationship to the severity and outcome of a traumatic brain injury. Methods : A cross sectional design was conducted in the emergency department of DR M Djamil Hospital, Padang. There were 72 patients who met the inclusion criteria. A Glasgow Coma Scale examination was performed to assess the severity of brain injury and examination of NSE serum levels at 48 hours post- injury using ELISA technique and assess the Glasgow outcome scale (GOS) at 6 weeks post-injury. Data analysis using SPSS 22 program, the results are significance if the p value <0.05  Results : The average NSE level was higher in severe brain injuries than moderate and mild brain injuries and this difference was statistically significant (p<0.05).  The NSE serum levels were higher in poor outcomes than in good outcomes and this difference was statistically significant (p<0.05).  Conclusion : High NSE serum levels in the acute phase were associated with the severity of the brain injury and poor outcome 6 weeks after the brain injury. 

scholarly journals Profil pasien cedera kepala sedang dan berat yang dirawat di ICU dan HCU

e-CliniC ◽  
2016 ◽  
Vol 4 (2) ◽  
Author(s):  
Maria L. Rawis ◽  
Diana Ch. Lalenoh ◽  
Lucky T. Kumaat
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Medical Record ◽  
Severe Traumatic Brain Injury ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Probability Sampling ◽  
Purposive Sampling

Abstract: Traumatic brain injuries are still the leading cause of death and disability, and require care on Intensive Care Unit (ICU). A traumatic brain injury caused by mechanical mass from outside the body, leads to impaired cognitive and psychosocial function that can occur temporarily or permanently, and can cause loss of consciousness. This study aims to determine the profile of the patients with moderate and severe traumatic brain injuries treated in ICU and HCU, using retrospective descriptive study conducted in September to November 2016 in the Medical Record department of Prof. Dr. R.D. Kandou, Manado. The sample size was determined by non-probability sampling method, a purposive sampling. Samples are ICU and HCU patients with the diagnosis of moderate to severe traumatic brain injury, who meet the inclusion criteria in the medical record of the data period September 2015 to August 2016. From the obtained sample of 40 patients, males dominate the gender category with 33 cases (83%). SIRS complications found in 23 cases (57.5%). Most patients are treated within 1–7 days, which also become the most patients who died within their length of stay. Patients who dies account for a total of 25 patients (62.5%) and most died after > 48 hours (72%) of treatment; out of the 25 deceased patients, 18 among them (45%) died from severe traumatic brain injury. Conclusion: The mortality rate is highest on severe head injury; most patients died after > 48 hours in the ICU and the HCU.Keywords: moderate traumatic brain injury, severe traumatic brain injury Abstrak: Cedera kepala masih merupakan penyebab utama kematian dan kecacatan, dan memerlukan perawatan Intensive Care Unit (ICU). Cedera kepala disebabkan oleh massa mekanik dari luar tubuh yang mengakibatkan gangguan fungsi kognitif dan psikososial, dapat terjadi sementara atau permanen, dan dapat menyebabkan penurunan kesadaran. Penelitian ini bertujuan untuk mengetahui profil pasien cedera kepala sedang dan berat yang dirawat pada ICU dan HCU, menggunakan metode penelitian deskriptif retrospektif yang dilakukan pada September sampai dengan November 2016 di Instalasi Rekam Medik RSUP Prof. Dr. R.D. Kandou, Manado. Besar sampel ditentukan dengan metode non probability sampling yaitu purposive sampling. Sampel penelitian adalah pasien ICU dan HCU dengan diagnosa cedera kepala sedang dan berat yang memenuhi kriteria inklusi pada data Rekam Medik periode September 2015 sampai dengan Agustus 2016. Hasil penelitian didapatkan jumlah sampel 40 pasien, dengan jenis kelamin terbanyak laki-laki 33 orang (83%). Komplikasi SIRS ditemui pada 23 kasus (57,5%). Paling banyak pasien dirawat pada 1–7 hari dan pasien yang meninggal dunia terbanyak pada lama rawat 1–7 hari. Pasien meninggal dunia berjumlah 25 orang (62,5%) dan terbanyak meninggal dunia setelah > 48 jam (72%); dari 25 orang yang meninggal dunia pasien dengan cedera kepala berat sebanyak 18 orang (45%). Simpulan: Angka mortalitas tertinggi ada pada cedera kepala berat, dan pasien meninggal dunia paling banyak setelah > 48 jam di ICU dan HCU. Kata kunci: cedera kepala sedang, cedera kepala berat

History, Overview, and Human Anatomical Pathology of Traumatic Brain Injury

Neurotrauma ◽  
2018 ◽  
pp. 3-12
Author(s):  
Kentaro Shimoda ◽  
Shoji Yokobori ◽  
Ross Bullock
Keyword(s):  
Traumatic Brain Injury ◽  
Young Adults ◽  
Intensive Care ◽  
Brain Injury ◽  
Brain Injuries ◽  
Research Effort ◽  
Intensive Care Treatment ◽  
Mortality And Morbidity ◽  
Severe Tbi ◽  
Anatomical Pathology

Traumatic brain injury (TBI) is one of the oldest and commonest causes of medical distress in humans. However, despite much research effort, the prognosis for severe TBI patients remains poor. Worldwide, TBI is recognized as the leading cause of mortality and morbidity in young adults. TBI is a major worldwide health and socioeconomic problem. The most important factor in the prognosis of TBI patients is the severity of the "primary" brain injury. Additional delayed "secondary" brain damage continues from the time of traumatic impact in TBI patients, and the two combine to determine outcome. This chapter discusses the incidence of TBI, trends in morbidity and mortality, shifts in causes of TBI, its economic burden on society, and the pathophysiology of primary and secondary brain injuries. The authors discuss indications for surgical and intensive care treatment for intracranial hypertension and mass lesion management in TBI patients.

scholarly journals VITAMIN-ANTIOXIDANT HOMEOSTASIS DATA IN PATIENTS WITH LONG-TERM CONSEQUENCES AFTER MILD TRAUMATIC BRAIN INJURY

2020 ◽  
Vol 46 (3) ◽  
pp. 15
Author(s):  
Y. V. Lekomtseva
Keyword(s):  
Traumatic Brain Injury ◽  
Vitamin E ◽  
Brain Injury ◽  
Vitamin C ◽  
Mild Traumatic Brain Injury ◽  
Brain Injuries ◽  
Serum Vitamin ◽  
Secondary Brain Injury ◽  
Long Term Consequences

Introduction. Mild traumatic brain injury (mTBI) was reported to be the most frequent among other types of brain injuries and is the main reason for the disability in mid-life and middleaged people. It’s known that antioxidants can reduce oxidative stress, so, to prevent secondary brain injury modulating maintaining of long-term consequences after mTBI. Purpose of the study. This work was to study the serum vitamin E, C and A levels in the patients with long-term consequences after mTBI to explore their potential pathogenetic influence. Materials and methods. Sixty-seven patients with long-term consequences after mTBI were investigated with the mean age of 43,61 ± 8,24 years (18 women, 26,86% and 49 men, 73,14%) where the vitamin E, C and A contents were measured in sera by spectrophotometer method using standard protocols and reagents (Sigma, USA).  Results. In this work, it was found descending serum levels of all investigated vitaminantioxidants in almost all patients with longterm consequences after mTBI where the content of vitamins A (M ± s: 1,63 ± 1,56 mkM/l) and E (25,41 ± 0,93 mkM/l) had a tendency to decreasing without significant differences compare to controls. It was found the statistically significant decreased of vitamin C levels in the serum samples of our investigated patients when compared to controls (p < 0,05, t = 4,59, 95% CI 98,81 to 55,68) where in the main patient group, the medians of total vitamin C level was 30,57 ± 5,38 mkM/l vs 36,91 ± 5,22 mkM/l in controls. It was shown that the patients with long-term consequences after mild contusion in anamnesis (64,18%) had the prominent changes in the vitamin C content. Conclusion. The maintaining of long-term consequences of mTBI was accompanied by the vitamin-antioxidant dyshomeostasis such as decreasing of vitamin C serum level associated with a tendency to decreasing of vitamins A and E levels that may play the certain role in the pathogenesis. All these data are needed to be accounted into the consideration during the treatment of this patient category. Keywords: long-term consequences of mild traumatic brain injury, vitamin-antioxidant homeostasis.

scholarly journals Coagulation disorder in moderate to severe traumatic brain injuries

2014 ◽  
Vol 6 (3) ◽  
pp. 22-25 ◽  
Author(s):  
Ajit Shrestha ◽  
Ramesh Man Joshi ◽  
Upendra P. Devkota
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Brain Injuries ◽  
International Normalized Ratio ◽  
Traumatic Brain Injuries ◽  
Coagulation Disorder ◽  
Secondary Brain Injury ◽  
Multivariate Statistical ◽  
Moderate Traumatic Brain Injury

Background: Significant proportions of patients presenting with moderate to severe traumatic brain injuries are diagnosed as having coagulation disorder and subsequent secondary brain injury. We evaluated the incidence of coagulopathy in patient with moderate to severe traumatic brain injury in this study.Methods: A prospective study of 100 patients with moderate to severe traumatic brain injury was carried out over a period of 2 years. Platelet count (PC), Bleeding time (BT), Clotting time (CT), Prothrombin time (PT), International Normalized ratio (INR), activated partial thromboplastin time (aPTT) and Fibrin degradation product (FDP) were measured at the time of admission and 12 hourly for 7 days. Daily D-dimer evaluation for DIC was performed in those who had abnormal value in any one of these parameters. Coagulopathy was classified as collectively 3 abnormal parameters.Results: Among the 100 patients, 43% had severe and 57% had moderate traumatic brain injury. Coagulopathy was detected in 63% of total patients; 76.7 % (33/43) among severe traumatic brain injury and 52.7 % (30/57) among moderate (p 0.013). Multivariate statistical analysis showed deranged FDP as a significant individual predictor of coagulopathy among others (p < 0.001, Odds ratio 166.25; 95% confidence interval 31.7 + 869.7).Conclusion: Coagulopathy is common in patients with moderate to severe traumatic brain injury. Evaluation of FDP can significantly predict coagulopathy in traumatic brain injury patients.DOI: http://dx.doi.org/10.3126/ajms.v6i3.10730 Asian Journal of Medical Sciences Vol.6(3) 2015 22-25

MANAGEMENT OF MULTIPLE TRAUMATIC INTRACRANIAL HEMATOMAS

2020 ◽  
Vol 3 (1) ◽  
pp. 70-74
Author(s):  
Rustam Hazratkulov ◽  
Keyword(s):  
Traumatic Brain Injury ◽  
Surgical Treatment ◽  
Brain Injury ◽  
Hospital Stay ◽  
Treatment Outcomes ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Diagnostic Approach ◽  
Early Activation ◽  
Intracranial Hematomas

Multiple traumatic hematomas (MG) account for 0.74% of all traumatic brain injuries. A comprehensive diagnostic approach to multiple traumatic intracranial hematomas allows to establish a diagnosis in the early stages of traumatic brain injury and to determine treatment tactics. A differentiated approach to the choice of surgical treatment of multiple hematomas allows to achieve satisfactory results and treatment outcomes, which accordingly contributes to the early activation of the patient, a reduction in hospital stay, a decrease in mortality and disabilityin patients with traumatic brain injury

One-year costs of intensive care in pediatric patients with traumatic brain injury

2021 ◽  
Vol 27 (1) ◽  
pp. 79-86
Author(s):  
Era D. Mikkonen ◽  
Markus B. Skrifvars ◽  
Matti Reinikainen ◽  
Stepani Bendel ◽  
Ruut Laitio ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Social Security ◽  
Functional Outcome ◽  
Injury Severity ◽  
Pediatric Population ◽  
Favorable Outcome ◽  
Index Hospitalization ◽  
Pediatric Tbi

OBJECTIVETraumatic brain injury (TBI) is a major cause of death and disability in the pediatric population. The authors assessed 1-year costs of intensive care in pediatric TBI patients.METHODSIn this retrospective multicenter cohort study of four academic ICUs in Finland, the authors used the Finnish Intensive Care Consortium database to identify children aged 0–17 years treated for TBI in ICUs between 2003 and 2013. The authors reviewed all patient health records and head CT scans for admission, treatment, and follow-up data. Patient outcomes included functional outcome (favorable outcome defined as a Glasgow Outcome Scale score of 4–5) and death within 6 months. Costs included those for the index hospitalization, rehabilitation, and social security up to 1 year after injury. To assess costs, the authors calculated the effective cost per favorable outcome (ECPFO).RESULTSIn total, 293 patients were included, of whom 61% had moderate to severe TBI (Glasgow Coma Scale [GCS] score 3–12) and 40% were ≥ 13 years of age. Of all patients, 82% had a favorable outcome and 9% died within 6 months of injury. The mean cost per patient was €48,719 ($54,557) (95% CI €41,326–€56,112). The index hospitalization accounted for 66%, rehabilitation costs for 27%, and social security costs for 7% of total healthcare costs. The ECPFO was €59,727 ($66,884) (95% CI €52,335–€67,120). A higher ECPFO was observed among patients with clinical and treatment-related variables indicative of parenchymal swelling and high intracranial pressure. Lower ECPFO was observed among patients with higher admission GCS scores and those who had epidural hematomas.CONCLUSIONSGreater injury severity increases ECPFO and is associated with higher postdischarge costs in pediatric TBI patients. In this pediatric cohort, over two-thirds of all resources were spent on patients with favorable functional outcome, indicating appropriate resource allocation.

Emotional Aspects of Pediatric Post-Intensive Care Syndrome Following Traumatic Brain Injury

2021 ◽  
Author(s):  
Kathryn R. Bradbury ◽  
Cydni Williams ◽  
Skyler Leonard ◽  
Emily Holding ◽  
Elise Turner ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Emotional Aspects ◽  
Post Intensive Care Syndrome
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