A standardized neurosurgical/neurointensive therapy directed toward vasogenic edema after severe traumatic brain injury: clinical results

Naredi, Silvana; Edén, Elisabeth; Zäll, S.; Stephensen, Hannes; Rydenhag, Bertil

doi:10.1007/s001340050594

Cited by 83 publications

(49 citation statements)

References 27 publications

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“…Decreased mortality in combination with increased favorable outcome has been reported in clinical studies [15,16,17]. The primary aim of this study was to evaluate the outcome of treatment according to the Lund concept in a pediatric population with severe TBI.…”

Section: Introductionmentioning

confidence: 99%

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

et al. 2005

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Objective: This study evaluated the outcome of treatment according to the Lund concept in children with severe traumatic brain injury and investigated whether the preset goals of the protocol were achieved. Design and setting: A twocenter retrospective study in neurointensive care units at university hospitals. Patients: Forty-one children with severe traumatic brain injury from blunt trauma and arriving at hospital within 24 h after injury. Median age was 8.8 years (range 3 months-14.2 years), Glasgow Coma Scale 7 (3-8), and Injury Severity Score 25 (16-75). All children had pathological findings on initial computed tomography. All developed intracranial hypertension, and survivors required intensive care longer than 72 h. Interventions: Treatment according to the principles of the Lund concept. Measurements and results: Neurosurgery was required in 46% of the children. Survival rate was 93% and favorable outcome (Glasgow Outcome Score 4 or 5) was 80% at long-term follow-up (median 12 months postinjury, range 2.5-26). The preset physiological and biochemical goals were achieved in over 90% of observations. Conclusions: Treating pediatric patients with severe traumatic brain injury, according to the Lund concept, results in a favorable outcome when the protocol is followed.

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Section: Introductionmentioning

confidence: 99%

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

et al. 2005

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“…An ICP-monitoring device is implanted when clinical signs indicate intracranial hypertension, and the patient is treated with a strict ICP-reducing protocol similar to that used in our hospital for post traumatic brain edema (13,14). This protocol, the Lund Concept for brain edema therapy, has been shown effective in reducing a raised ICP and in improving outcome of brain trauma (15,16). In the present paper we describe serial invasive ICP measurements in the patients admitted to our hospital with severe life-threatening bacterial meningitis, the relationship between ICP and therapeutic intervention, as well as the functional outcome.…”

mentioning

confidence: 99%

Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis

Grände

Myhre

Nordström

et al. 2002

Acta Anaesthesiol Scand

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Background: Brain stem herniation due to raised intracranial pressure (ICP) is a common cause of mortality in severe bacterial meningitis, but continuous measurements of ICP and the effects of ICP-reducing therapy in these patients have, to our knowledge, not been described. Methods: During a four-year period, an ICP-monitoring device was implanted in patients admitted to our hospital with severe bacterial meningitis and suspected intracranial hypertension. ICP above 20 mmHg was treated using the Lund Concept, which includes antihypertensive therapy (b 1 -antagonist,a 2 -agonist), normalization of the plasma colloid osmotic pressure and the blood volume, and antistress therapy. Results: ICP above 20 mmHg was found in all 12 patients studied. It was effectively reduced in all but two patients, who died. Both patients had a low cerebral perfusion pressure (Ͻ10 mmHg), dilated pupils at start of therapy and were beyond recovery. Radiological signs of brain swelling were present in only five patients. Seven patients recovered fully, while mild audiological impairment was observed in two and minor neurological sequelae in one patient. Eight patients showed signs suggesting imminent brain stem herniation before start of ICP-reducing treatment, seven of whom had been subjected to diagnostic lum-

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“…Clinical outcome of volume-targeted therapy according to the "Lund-concept" has been reported from four Swedish neurosurgical centres (5,6,11,12). All four studies have shown a remarkably low mortality.…”

Section: Clinical Resultsmentioning

confidence: 99%

The Lund concept: is this logical?

Nordström

2005

Intracranial Pressure and Brain Monitoring XII

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SummaryThe optimal therapy of sustained increase in intracranial pressure (ICP) is still controversial. The "Lund concept" is based on the physiological volume regulation of the intracranial compartments. In addition to its other functions the blood-brain barrier (BBB) is the most important regulator of brain volume. Water exchange across the intact BBB is counteracted by the low permeability to crystalloids (mainly Na + and Cl -) combined with the high osmotic pressure (5,700 mm Hg) on both sides of the BBB. If the BBB is disrupted transcapillary water transport will be determined by the differences in hydrostatic and colloid osmotic pressure between the intra-and extracapillary compartments. Under pathological conditions pressure autoregulation of cerebral blood flow is often impaired and intracapillary hydrostatic pressure will depend on variations in systemic blood pressure.

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A standardized neurosurgical/neurointensive therapy directed toward vasogenic edema after severe traumatic brain injury: clinical results

Abstract: A therapy focusing on treatment of the assumed vasogenic edema in combination with aggressive neurosurgery resulted in an outcome as good as the best previously reported.

Cited by 83 publications

References 27 publications

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis

The Lund concept: is this logical?

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