The brain-lung interaction can seriously affect patients with traumatic brain injury, triggering a vicious cycle that worsens patient prognosis. Although the mechanisms of the interaction are not fully elucidated, several hypotheses, notably the "blast injury" theory or "double hit" model, have been proposed and constitute the basis of its development and progression. The brain and lungs strongly interact via complex pathways from the brain to the lungs but also from the lungs to the brain. The main pulmonary disorders that occur after brain injuries are neurogenic pulmonary edema, acute respiratory distress syndrome, and ventilator-associated pneumonia, and the principal brain disorders after lung injuries include brain hypoxia and intracranial hypertension. All of these conditions are key considerations for management therapies after traumatic brain injury and need exceptional case-by-case monitoring to avoid neurological or pulmonary complications. This review aims to describe the history, pathophysiology, risk factors, characteristics, and complications of brain-lung and lung-brain interactions and the impact of different old and recent modalities of treatment in the context of traumatic brain injury.
ObjectiveTo analyze the clinical characteristics, complications and factors associated with
the prognosis of severe traumatic brain injury among patients who undergo a
decompressive craniectomy.MethodsRetrospective study of patients seen in an intensive care unit with severe
traumatic brain injury in whom a decompressive craniectomy was performed between
the years 2003 and 2012. Patients were followed until their discharge from the
intensive care unit. Their clinical-tomographic characteristics, complications,
and factors associated with prognosis (univariate and multivariate analysis) were
analyzed.ResultsA total of 64 patients were studied. Primary and lateral decompressive
craniectomies were performed for the majority of patients. A high incidence of
complications was found (78% neurological and 52% nonneurological). A total of 42
patients (66%) presented poor outcomes, and 22 (34%) had good neurological
outcomes. Of the patients who survived, 61% had good neurological outcomes. In the
univariate analysis, the factors significantly associated with poor neurological
outcome were postdecompressive craniectomy intracranial hypertension, greater
severity and worse neurological state at admission. In the multivariate analysis,
only postcraniectomy intracranial hypertension was significantly associated with a
poor outcome.ConclusionThis study involved a very severe and difficult to manage group of patients with
high morbimortality. Intracranial hypertension was a main factor of poor outcome
in this population.
Dexmedetomidine, an alpha 2 adrenergic agonist, with distinctive characteristics when compared to traditional plans, namely: conscious sedation, sympatholysis and lack of respiratory depression, represents an attempt to improve the sedoanalgesia of critically ill patients. OBJECTIVE. To study dexmedetomidine's effect on intracranial hemodynamic and hemometabolic parameters in severe head injured patients. MATERIAL AND METHODS. Prospective study on the effect of Dexmedetomidine on twelve severe head injured patients (Glasgow Coma Scale score
Background: Cadaveric studies on humans have shown anatomical variabilities in the morphometric characteristics of the tentorial notch. These anatomical variations could influence the worsening of neurocritical patients. Objectives: 1) To investigate the morphometric characteristics of the tentorial notch in neurocritical patients using computed tomography (CT); 2) To investigate the correlation between tentorial notch measurements by CT and by magnetic resonance imaging (MRI); and 3) To analyze the individual variability of the tentorial notch anatomy seen in neurocritical patients. Methods: Prospective series of neurocritical patients was examined. An imaging protocol for measurements was designed for CT and MRI. The level of the agreement of the measurements from CT and MR images was established. According to the measurements found, patients were divided into different types of tentorial notch. Results: We studied 34 neurocritical patients by CT and MRI. Measurements of the tentorial notch via CT and MRI showed significant agreement: concordance correlation coefficient of 0.96 for notch length and 0.85 for maximum width of tentorial notch. Classification of tentorial notch measurements according to the criteria established by Adler and Milhorat, we found the following: 15 patients (58%) corresponded to a "short" subtype; 7 (21%) to "small"; 3 (9%) to "narrow"; 2 (6%) to "wide"; 2 (6%) to “large”; 1 (3%) to “long”; and 4 (12%) to "typical". Conclusions: The anatomical variability of the tentorial notch could be detected in vivo by means of CT scan and MRI. Good agreement between the measurements made using these two imaging methods was found.
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