Acute Management of Moderate-Severe Traumatic Brain Injury

Whitaker-Lea, Wittstatt Alexandra; Valadka, Alex B.

doi:10.1016/j.pmr.2016.12.002

Cited by 15 publications

(9 citation statements)

References 31 publications

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“…Unfortunately, the heterogeneity of trauma based on injury location and severity, as well as patient age and associated comorbidities, has posed a significant challenge in the development of effective therapies for TBI [8] . As a consequence, current neurocritical care still focuses primarily on prevention of TBI and stabilizing TBI patients [9] .…”

Section: Introductionmentioning

confidence: 99%

NADPH oxidases in traumatic brain injury – Promising therapeutic targets?

et al. 2018

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Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Despite intense investigation, no neuroprotective agents for TBI have yet translated to the clinic. Recent efforts have focused on identifying potential therapeutic targets that underlie the secondary TBI pathology that evolves minutes to years following the initial injury. Oxidative stress is a key player in this complex cascade of secondary injury mechanisms and prominently contributes to neurodegeneration and neuroinflammation. NADPH oxidase (NOX) is a family of enzymes whose unique function is to produce reactive oxygen species (ROS). Human post-mortem and animal studies have identified elevated NOX2 and NOX4 levels in the injured brain, suggesting that these two NOXs are involved in the pathogenesis of TBI. In support of this, NOX2 and NOX4 deletion studies have collectively revealed that targeting NOX enzymes can reduce oxidative stress, attenuate neuroinflammation, promote neuronal survival, and improve functional outcomes following TBI. In addition, NOX inhibitor studies have confirmed these findings and demonstrated an extended critical window of efficacious TBI treatment. Finally, the translational potential, caveats, and future directions of the field are highlighted and discussed throughout the review.

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Section: Introductionmentioning

confidence: 99%

NADPH oxidases in traumatic brain injury – Promising therapeutic targets?

et al. 2018

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“…Such early medical intervention would then result in a stabilized airway, breathing, and circulation. Management goals for traumatic brain injury include the prevention and prompt treatment of secondary insults (hypotension, hypoxia, and other physiological derangements) 9 ) . In contrast, EMTs can use bag valve mask ventilation to improve the airway and breathing before patients enter cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

“…At least in the prehospital setting, the available evidence does not suggest any marked benefit from pre-hospital tracheal intubation and mechanical ventilation after traumatic brain injury 10 ) . Furthermore, decreased cerebral perfusion pressure induced by the administration of sedatives or pain killers in the HEMS may deteriorate the outcome of patients who experience severe brain injury 9 , 11 ) . Of note, Bekelis et al reported that helicopter transport of individuals who experience traumatic brain injury to trauma centers was associated with improved survival compared with transport by ground ambulance 12 ) .…”

Section: Discussionmentioning

confidence: 99%

The utility of physician-staffed helicopters for managing individuals who experience severe isolated head trauma

et al. 2021

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Objective: The authors retrospectively investigated prognostic factors for severe isolated head trauma in patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) or ground ambulance using data from the Japan Trauma Data Bank (JTDB). Patients and Methods: This study was a retrospective analysis of data housed in the JTDB database. The study period was from January 2004 to May 2019. Subjects were divided into two groups according to the method of transportation: helicopter (i.e., HEMS), which included patients transported by a physician-staffed helicopter; and ambulance, which included patients transported by ground ambulance. Results: A total of 41,358 patients were enrolled in the study, including 2,029 in the helicopter group and 39,329 in the ambulance group. The ratio of males, median head Abbreviated Injury Scale and Injury Severity Scale (ISS) scores were significantly greater in the helicopter group than in the ambulance group, while the average age, median Glasgow Coma Scale, average Revised Trauma Score (RTS), and survival rate were significantly lower in the helicopter group than in the ambulance group. Of the variables that demonstrated statistical significance in the univariate analysis and classification of transportation and included in the multivariate analysis, the following were identified as significant predictors of survival outcomes: younger age, lower ISS, female sex, and greater RTS. HEMS was not a significant predictor of survival. Conclusion:The present study revealed no effect of HEMS transport on the outcomes of patients who experienced severe isolated head trauma compared with ground ambulance transportation. Further prospective studies, including an analysis of the operation time or distance traveled by the HEMS and the functional outcome(s) of patients with severe head injury transported by HEMS, are warranted.

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“…This is in accordance with. [22] that reported an increased mortality and morbidity in elderly populations attributed to systemic complications such as pulmonary infection. Also [23] reported that there is strong correlation Open Journal of Modern Neurosurgery exists between age and outcome (which could not be proved in the present work).…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcome of Traumatic Intracranial Hematoma

Hendam¹,

Taha²

2020

OJMN

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Objective: To evaluate the factors affecting the surgical outcome of traumatic intracranial hematoma. Patient and Methods: This study was retrospectively conducted on 60 patients with traumatic intracranial hematoma admitted to the Neurosurgery Department, Al-Azhar University Hospital and underwent surgical management. Results: The age range was 10 -58 years, mean age was 31.50 years, male-to-female ratio was 3:1. The causative trauma was road traffic accident (45%), direct trauma to the head (30%) and fall from height (FFH) (25%) of all studied patients. Morbidity and/or mortality was reported in 38.3% and unfavorable outcome was significantly associated with longer delay time (time from injury to surgery), increased operative time, long duration of hospital stay and lower Glasgow coma scale at admission and discharge. Otherwise, the unfavorable outcome although increased with old age, there was no significant association. Conclusion: Head trauma is considered as a frequent cause of death and disability. Time consuming to reach the hospital, operative time, length of stay in hospital and Glasgow coma score of the patient on admission and discharge markedly determine the surgical outcome of traumatic intracranial hematoma.

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Acute Management of Moderate-Severe Traumatic Brain Injury

Cited by 15 publications

References 31 publications

NADPH oxidases in traumatic brain injury – Promising therapeutic targets?

NADPH oxidases in traumatic brain injury – Promising therapeutic targets?

The utility of physician-staffed helicopters for managing individuals who experience severe isolated head trauma

Surgical Outcome of Traumatic Intracranial Hematoma

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