Approaches to Multimodality Monitoring in Pediatric Traumatic Brain Injury

Appavu, Brian; Burrows, Brian T.; Foldes, Stephen T.; Adelson, P. David

doi:10.3389/fneur.2019.01261

Cited by 26 publications

(19 citation statements)

References 70 publications

(64 reference statements)

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“…[52] This technique utilizes the Doppler shift principle to obtain the red blood cell mean flow velocity from pulses of high-frequency ultrasound waves which are aimed at basal cerebral arteries; the reflection causes a change in direction and velocity, which is used to determine the CBF. [65,66] The overall sensitivity of TCD for determining brain death is 75-88% and the overall specificity is reported to be 98%. [52] However, TCD is unable to distinguish between the symptomatic and asymptomatic measurements ranging at velocities between 120 and 199 cm s À1 .…”

Section: Cerebral Blood Flow (Cbf)mentioning

confidence: 99%

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Recent Technological Developments in the Diagnosis and Treatment of Cerebral Edema

Deshmukh

Dabbagh

Jiang

et al. 2021

Advanced NanoBiomed Research

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Latest technological advancements in neurocritical care have translated to improved clinical outcomes and have paved the way for the effective diagnosis and treatment of cerebral edema. Effective management of cerebral edema has the potential to provide a personalized treatment by obtaining the complete pathophysiological information of the patient. The aims of this review are to inform the reader about the research and development in this field in the past decade as well as the materialization of scientific literature through patents. There is a growing interest in multimodal monitoring of the diseased brain as it provides a necessary means to implement effective intervention strategies. Although there is a gradual shift toward the adoption of noninvasive devices for research purposes, their clinical applications are hindered by their inaccuracies. However, the inherent risk of complication and high costs of implementation challenge the status quo. The role of neuroprotectants is explored and the combination of neurodiagnostic and neuroprotective approaches is proposed. Finally, the impacts of the current state of global affairs are discussed and it is predicted that the rising number of traumatic brain injury patents will inevitably translate to improvements in technologies to effectively address cerebral edema.

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Section: Cerebral Blood Flow (Cbf)mentioning

confidence: 99%

“…[118], and ref. [66]; NR ¼ not reported. Please refer to Table 6 for an extensive comparison of the various imaging techniques.…”

Section: Volumetric Electromagnetic Phase Shift Spectroscopy (Veps)mentioning

confidence: 99%

Recent Technological Developments in the Diagnosis and Treatment of Cerebral Edema

Deshmukh

Dabbagh

Jiang

et al. 2021

Advanced NanoBiomed Research

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“…Increasing evidence also suggests that model-based indices of cerebral autoregulation (CA) and brain compliance may represent potentially modifiable biomarkers of injury severity after pediatric and adult TBI [ 5 , 6 ]. Standardized processes of assessing and reporting MMM data are not well described and despite increasing use of MMM in neurocritical care, no studies have investigated the association of MMM with functional outcome or adverse events after TBI [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of Multimodality Neurologic Monitoring Reporting in Pediatric Traumatic Brain Injury Management

et al. 2021

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Background/Objective Multimodality neurologic monitoring (MMM) is an emerging technique for management of traumatic brain injury (TBI). An increasing array of MMM-derived biomarkers now exist that are associated with injury severity and functional outcomes after TBI. A standardized MMM reporting process has not been well described, and a paucity of evidence exists relating MMM reporting in TBI management with functional outcomes or adverse events. Methods Prospective implementation of standardized MMM reporting at a single pediatric intensive care unit (PICU) is described that included monitoring of intracranial pressure (ICP), cerebral oxygenation and electroencephalography (EEG). The incidence of clinical decisions made using MMM reporting is described, including timing of neuroimaging, ICP monitoring discontinuation, use of paralytic, hyperosmolar and pentobarbital therapies, neurosurgical interventions, ventilator and CPP adjustments and neurologic prognostication discussions. Retrospective analysis was performed on the association of MMM reporting with initial Glasgow Coma Scale (GCS) and Pediatric Risk of Mortality III (PRISM III) scores, duration of total hospitalization and PICU hospitalization, duration of mechanical ventilation and invasive ICP monitoring, inpatient complications, time with ICP > 20 mmHg, time with cerebral perfusion pressure (CPP) < 40 mmHg and 12-month Glasgow Outcome Scale—Extended Pediatrics (GOSE-Peds) scores. Association of outcomes with MMM reporting was investigated using the Wilcoxon rank-sum test or Fisher’s exact test, as appropriate. Results Eighty-five children with TBI underwent MMM over 6 years, among which 18 underwent daily MMM reporting over a 21-month period. Clinical decision-making influenced by MMM reporting included timing of neuroimaging (100.0%), ICP monitoring discontinuation (100.0%), timing of extubation trials of surviving patients (100.0%), body repositioning (11.1%), paralytic therapy (16.7%), hyperosmolar therapy (22.2%), pentobarbital therapy (33.3%), provocative cerebral autoregulation testing (16.7%), adjustments in CPP thresholds (16.7%), adjustments in PaCO2 thresholds (11.1%), neurosurgical interventions (16.7%) and neurologic prognostication discussions (11.1%). The implementation of MMM reporting was associated with a reduction in ICP monitoring duration (p = 0.0017) and mechanical ventilator duration (p = 0.0018). No significant differences were observed in initial GCS or PRISM III scores, total hospitalization length, PICU hospitalization length, total complications, time with ICP > 20 mmHg, time with CPP < 40 mmHg, use of tier 2 therapy, or 12-month GOS-E Peds scores. Conclusion Implementation of MMM reporting in pediatric TBI management is feasible and can be impactful in tailoring clinical decisions. Prospective work is needed to understand the impact of MMM and MMM reporting systems on functional outcomes and clinical care efficacy. ...

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“…Dysfunction in learning and memory is a type of brain sequelae in the mechanism of TBI or secondary TBI, which is mainly induced by abnormal activity in the hippocampus. Current evidence has shown that post-TBI dysfunction in learning and memory involves significantly complicated pathologies, including neuronal death and dysfunction in the synapse, hippocampus, or brain network (4)(5)(6). So far, decades of efforts have been focused on drugs that are able to improve the dysfunction in learning and memory; however, unfortunately, an effective drug that can be used for the treatment of post-TBI dysfunction in learning and memory is not yet available (7).…”

Section: ' Introductionmentioning

confidence: 99%

Edaravone Improves the Post-traumatic Brain Injury Dysfunction in Learning and Memory by Modulating Nrf2/ARE Signal Pathway

Li¹,

Yu²,

Ma³

et al. 2021

Clinics

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To investigate the molecular mechanism of edaravone (EDA) in improving the post-traumatic brain injury (TBI) dysfunction in learning and memory. METHODS: In vitro and in vivo TBI models were established using hydrogen peroxide (H 2 O 2 ) treatment for hippocampal nerve stem cells (NSCs) and surgery for rats, followed by EDA treatment. WST 1 measurement, methylthiazol tetrazolium assay, and flow cytometry were performed to determine the activity, proliferation, and apoptosis of NSCs, and malondialdehyde (MDA), lactic dehydrogenase (LDH), and reactive oxygen species (ROS) detection kits were used to analyze the oxides in NSCs. RESULTS: Following EDA pretreatment, NSCs presented with promising resistance to H 2 O 2 -induced oxidative stress, whereas NSCs manifested significant increases in activity and proliferation and a decrease in apoptosis. Meanwhile, for NSCs, EDA pretreatment reduced the levels of MDA, LDH, and ROS, with a significant upregulation of Nrf2/antioxidant response element (ARE) signaling pathway, whereas for EDA-treated TBI rats, a significant reduction was observed in the trauma area and injury to the hippocampus, with improvement in memory and learning performance and upregulation of Nrf2/ARE signaling pathway. CONCLUSIONS: EDA, by regulating the activity of Nrf2/ARE signal pathway, can improve the TBI-induced injury to NSCs and learning and memory dysfunction in rats.

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Approaches to Multimodality Monitoring in Pediatric Traumatic Brain Injury

Cited by 26 publications

References 70 publications

Recent Technological Developments in the Diagnosis and Treatment of Cerebral Edema

Recent Technological Developments in the Diagnosis and Treatment of Cerebral Edema

Implementation of Multimodality Neurologic Monitoring Reporting in Pediatric Traumatic Brain Injury Management

Edaravone Improves the Post-traumatic Brain Injury Dysfunction in Learning and Memory by Modulating Nrf2/ARE Signal Pathway

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