2019年国际专家团基于Delphi方法的反复调查和现场讨论,完成了"A management algorithm for patients with intracranial pressure monitoring:the Seattle International Severe Traumatic Brain Injury Consensus Conference(SIB...2019年国际专家团基于Delphi方法的反复调查和现场讨论,完成了"A management algorithm for patients with intracranial pressure monitoring:the Seattle International Severe Traumatic Brain Injury Consensus Conference(SIBICC)"(简称"共识"),旨在引导对仅行颅内压监测的颅脑创伤患者实施合理的分级管理。本文对"共识"所涉及的"三阶梯颅内压管理流程"、各级治疗措施的应用原则,以及镇静治疗和颅内压监测停撤的判断流程进行解读,以期将国际颅脑创伤神经重症研究进展介绍给读者。展开更多
Objective To investigate the role of decompressive craniectomy (DC) to decrease intractable intracranial hypertension(ICH) due to diffuse brain swelling and / or cerebral edema after severe traumatic brain injury and ...Objective To investigate the role of decompressive craniectomy (DC) to decrease intractable intracranial hypertension(ICH) due to diffuse brain swelling and / or cerebral edema after severe traumatic brain injury and the time window of DC to affect on prognosis. Methods The clinical record of 132 patients who underwent DC for posttraumatic intractable ICH in our hospital from July 2003 to展开更多
Background Patients with acute brain injury(ABI)are a peculiar population because ABI does not only affect the brain but also other organs such as the lungs,as theorized in brain–lung crosstalk models.ABI patients of...Background Patients with acute brain injury(ABI)are a peculiar population because ABI does not only affect the brain but also other organs such as the lungs,as theorized in brain–lung crosstalk models.ABI patients often require mechanical ventilation(MV)to avoid the complications of impaired respiratory function that can follow ABI;MV should be settled with meticulousness owing to its effects on the intracranial compartment,especially regarding positive end-expiratory pressure(PEEP).This scoping review aimed to(1)describe the physiological basis and mechanisms related to the effects of PEEP in ABI;(2)examine how clinical research is conducted on this topic;(3)identify methods for setting PEEP in ABI;and(4)investigate the impact of the application of PEEP in ABI on the outcome.Methods The five-stage paradigm devised by Peters et al.and expanded by Arksey and O'Malley,Levac et al.,and the Joanna Briggs Institute was used for methodology.We also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)extension criteria.Inclusion criteria:we compiled all scientific data from peer-reviewed journals and studies that discussed the application of PEEP and its impact on intracranial pressure,cerebral perfusion pressure,and brain oxygenation in adult patients with ABI.Exclusion criteria:studies that only examined a pediatric patient group(those under the age of 18),experiments conducted solely on animals;studies without intracranial pressure and/or cerebral perfusion pressure determinations,and studies with incomplete information.Two authors searched and screened for inclusion in papers published up to July 2023 using the PubMed-indexed online database.Data were presented in narrative and tubular form.Results The initial search yielded 330 references on the application of PEEP in ABI,of which 36 met our inclusion criteria.PEEP has recognized beneficial effects on gas exchange,but it produces hemodynamic changes that should be predicted to avoid undesired consequences on cerebral blood flow and intracranial pressure.Moreover,the elastic properties of the lungs influence the transmission of the forces applied by MV over the brain so they should be taken into consideration.Currently,there are no specific tools that can predict the effect of PEEP on the brain,but there is an established need for a comprehensive monitoring approach for these patients,acknowledging the etiology of ABI and the measurable variables to personalize MV.Conclusion PEEP can be safely used in patients with ABI to improve gas exchange keeping in mind its potentially harmful effects,which can be predicted with adequate monitoring supported by bedside non-invasive neuromonitoring tools.展开更多
Traumatic brain injury(TBI) is a major cause of death and disability in children. Severe TBI is a leading cause of death and often leads to life changing disabilities in survivors. The modern management of severe TBI ...Traumatic brain injury(TBI) is a major cause of death and disability in children. Severe TBI is a leading cause of death and often leads to life changing disabilities in survivors. The modern management of severe TBI in children on intensivecare unit focuses on preventing secondary brain injury to improve outcome. Standard neuroprotective measures are based on management of intracranial pressure(ICP) and cerebral perfusion pressure(CPP) to optimize the cerebral blood flow and oxygenation, with the intention to avoid and minimise secondary brain injury. In this article, we review the current trends in management of severe TBI in children, detailing the general and specific measures followed to achieve the desired ICP and CPP goals. We discuss the often limited evidence for these therapeutic interventions in children, extrapolation of data from adults, and current recommendation from paediatric guidelines. We also review the recent advances in understanding the intracranial physiology and neuroprotective therapies, the current research focus on advanced and multi-modal neuromonitoring, and potential new therapeutic and prognostic targets.展开更多
Objectives: To evaluate the efficacy of Decompressive Craniectomy (DC) on the postoperative clinical state of the patient to define a line of management of these cases. Take in considerations the surrounding circumsta...Objectives: To evaluate the efficacy of Decompressive Craniectomy (DC) on the postoperative clinical state of the patient to define a line of management of these cases. Take in considerations the surrounding circumstances of the patient till he reaches the ER in Egypt and the hospital resources. Methods: 200 patients suffering from acute traumatic brain injury causing DCL resulted from different pathologies causing increased ICP. In group A, patients with acute TBI were managed by surgical intervention in the form of Decompressive Craniectomy and in the control group B, patients were managed by medical treatment. The age range was from 8 to 65 with no history of associated medical disorders with exclusion criteria of non-traumatic causes of increased ICP. Results: Data collected showed: male to female ratio of 3:1. The most common mode of injury was falling from height. Mean time from injury to operative intervention was 4 hours. The leading initial symptoms were DCL. In group A the overall mortality was 60%, functional recovery rate was 30%, and left severely disabled or vegetative was 10%. 50% of the cases had associated injury. 20% suffered from post-operative complications. Conclusion: DC is the ideal solution for the management of acute TBI with persistent increased ICP when the other medical management fails, given an early intervention and taking into consideration other factors affecting surgical outcome.展开更多
文摘2019年国际专家团基于Delphi方法的反复调查和现场讨论,完成了"A management algorithm for patients with intracranial pressure monitoring:the Seattle International Severe Traumatic Brain Injury Consensus Conference(SIBICC)"(简称"共识"),旨在引导对仅行颅内压监测的颅脑创伤患者实施合理的分级管理。本文对"共识"所涉及的"三阶梯颅内压管理流程"、各级治疗措施的应用原则,以及镇静治疗和颅内压监测停撤的判断流程进行解读,以期将国际颅脑创伤神经重症研究进展介绍给读者。
文摘Objective To investigate the role of decompressive craniectomy (DC) to decrease intractable intracranial hypertension(ICH) due to diffuse brain swelling and / or cerebral edema after severe traumatic brain injury and the time window of DC to affect on prognosis. Methods The clinical record of 132 patients who underwent DC for posttraumatic intractable ICH in our hospital from July 2003 to
文摘Background Patients with acute brain injury(ABI)are a peculiar population because ABI does not only affect the brain but also other organs such as the lungs,as theorized in brain–lung crosstalk models.ABI patients often require mechanical ventilation(MV)to avoid the complications of impaired respiratory function that can follow ABI;MV should be settled with meticulousness owing to its effects on the intracranial compartment,especially regarding positive end-expiratory pressure(PEEP).This scoping review aimed to(1)describe the physiological basis and mechanisms related to the effects of PEEP in ABI;(2)examine how clinical research is conducted on this topic;(3)identify methods for setting PEEP in ABI;and(4)investigate the impact of the application of PEEP in ABI on the outcome.Methods The five-stage paradigm devised by Peters et al.and expanded by Arksey and O'Malley,Levac et al.,and the Joanna Briggs Institute was used for methodology.We also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)extension criteria.Inclusion criteria:we compiled all scientific data from peer-reviewed journals and studies that discussed the application of PEEP and its impact on intracranial pressure,cerebral perfusion pressure,and brain oxygenation in adult patients with ABI.Exclusion criteria:studies that only examined a pediatric patient group(those under the age of 18),experiments conducted solely on animals;studies without intracranial pressure and/or cerebral perfusion pressure determinations,and studies with incomplete information.Two authors searched and screened for inclusion in papers published up to July 2023 using the PubMed-indexed online database.Data were presented in narrative and tubular form.Results The initial search yielded 330 references on the application of PEEP in ABI,of which 36 met our inclusion criteria.PEEP has recognized beneficial effects on gas exchange,but it produces hemodynamic changes that should be predicted to avoid undesired consequences on cerebral blood flow and intracranial pressure.Moreover,the elastic properties of the lungs influence the transmission of the forces applied by MV over the brain so they should be taken into consideration.Currently,there are no specific tools that can predict the effect of PEEP on the brain,but there is an established need for a comprehensive monitoring approach for these patients,acknowledging the etiology of ABI and the measurable variables to personalize MV.Conclusion PEEP can be safely used in patients with ABI to improve gas exchange keeping in mind its potentially harmful effects,which can be predicted with adequate monitoring supported by bedside non-invasive neuromonitoring tools.
文摘Traumatic brain injury(TBI) is a major cause of death and disability in children. Severe TBI is a leading cause of death and often leads to life changing disabilities in survivors. The modern management of severe TBI in children on intensivecare unit focuses on preventing secondary brain injury to improve outcome. Standard neuroprotective measures are based on management of intracranial pressure(ICP) and cerebral perfusion pressure(CPP) to optimize the cerebral blood flow and oxygenation, with the intention to avoid and minimise secondary brain injury. In this article, we review the current trends in management of severe TBI in children, detailing the general and specific measures followed to achieve the desired ICP and CPP goals. We discuss the often limited evidence for these therapeutic interventions in children, extrapolation of data from adults, and current recommendation from paediatric guidelines. We also review the recent advances in understanding the intracranial physiology and neuroprotective therapies, the current research focus on advanced and multi-modal neuromonitoring, and potential new therapeutic and prognostic targets.
文摘Objectives: To evaluate the efficacy of Decompressive Craniectomy (DC) on the postoperative clinical state of the patient to define a line of management of these cases. Take in considerations the surrounding circumstances of the patient till he reaches the ER in Egypt and the hospital resources. Methods: 200 patients suffering from acute traumatic brain injury causing DCL resulted from different pathologies causing increased ICP. In group A, patients with acute TBI were managed by surgical intervention in the form of Decompressive Craniectomy and in the control group B, patients were managed by medical treatment. The age range was from 8 to 65 with no history of associated medical disorders with exclusion criteria of non-traumatic causes of increased ICP. Results: Data collected showed: male to female ratio of 3:1. The most common mode of injury was falling from height. Mean time from injury to operative intervention was 4 hours. The leading initial symptoms were DCL. In group A the overall mortality was 60%, functional recovery rate was 30%, and left severely disabled or vegetative was 10%. 50% of the cases had associated injury. 20% suffered from post-operative complications. Conclusion: DC is the ideal solution for the management of acute TBI with persistent increased ICP when the other medical management fails, given an early intervention and taking into consideration other factors affecting surgical outcome.
