Early Indicators of Prognosis in 846 Cases of Severe Traumatic Brain Injury

Jiang, Jiyao; Gao, Guoyi; Li, Weiping; Yu, Mei; Zhu, Cheng

doi:10.1089/08977150260190456

Cited by 275 publications

(158 citation statements)

References 20 publications

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“…The insult triggers an invasion of macrophages and neutrophils into the impact area, producing much of the inflammation and swelling associated with CNS damage. These potentially cytotoxic events can directly affect patient outcome after TBI, which can be further worsened by uncontrolled intracranial pressure (ICP) [17] caused by a rise in brain water content (cerebral edema) [18]. Uncontrolled ICP can produce greater secondary injury through ischemia [39] and an increase in mortality caused by herniation of the brain [23].…”

Section: Introductionmentioning

confidence: 99%

Neurosteroids reduce inflammation after TBI through CD55 induction

VanLandingham

Cekić

Cutler

et al. 2007

Neuroscience Letters

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The inflammatory cascade that follows traumatic brain injury may lead to secondary cell death and can impede recovery of function. Complement factors and their convertases are increased in glia after brain injury and lead to the production of inflammatory products that kill vulnerable neurons. Progesterone and its metabolite allopregnanolone (5α-pregnan-3β-ol-20-one) have been shown to reduce the expression of inflammatory cytokines in the acute stages of brain injury, although how they do this is not completely understood. In this study we show that both progesterone and allopregnanolone treatments enhance the production of CD55 following contusion injuries of the cerebral cortex in rats. CD55, a single-chain type 1 cell surface protein, is a potent inhibitor of the complement convertases which are activators of the inflammatory cascade. The increased expression of CD55 could be an important mechanism by which steroids help to reduce the cerebral damage caused by inflammation.

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Section: Introductionmentioning

confidence: 99%

Neurosteroids reduce inflammation after TBI through CD55 induction

VanLandingham

Cekić

Cutler

et al. 2007

Neuroscience Letters

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“…However in certain patient populations, temperature elevations may be extremely detrimental and intervention is necessary. One such population is patients with traumatic brain injury (TBI) where the presence of fever in the acute phase is associated with worse outcomes for patients including longer intensive care unit (ICU) stays, increased intracranial pressure, lower Glasgow Coma Scale scores, and poorer functional status (Natale et al, 2000;Jiang et al, 2002;Stocchetti et al, 2002;Diringer et al, 2004). In the presence of TBI, fever may be associated with increased excitatory amino acid release, increased vasogenic edema, increased intracranial pressure, and increased metabolic expenditure, ultimately resulting in increased neuronal loss (for review see Thompson et al, 2003b).…”

Section: Introductionmentioning

confidence: 99%

Intensive care unit management of fever following traumatic brain injury

Thompson

Kirkness

Mitchell

2007

Intensive and Critical Care Nursing

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SummaryFever, in the presence of traumatic brain injury (TBI), is associated with worsened neurologic outcomes. Studies prior to the publication of management guidelines revealed an undertreatment of fever in patients with neurologic insults. Presently the adult TBI guidelines state that maintenance of normothermia should be a standard of care therefore improvement in management of fever in these patients would be expected. The specific aims of the study were to: 1) determine the incidence of fever (T> 38.5° C) in a population of critically ill patients with TBI. 2) describe what interventions were recorded by intensive care unit (ICU) nurses in managing fever. 3) ascertain the rate of adherence with published normothermia guidelines. Medical record review of available hospital records was conducted on patients admitted to a level I trauma center following severe TBI (N=108) from the parent study. Temperature data was abstracted and contemporaneous nursing documentation was examined for evidence of intervention for fever and adherence with published standards. Data analyses were performed that included descriptive statistics. Seventy-nine percent of TBI patients (85/108) had at least one recorded fever event while in the ICU. However in only 31% of events did the patient receive any documented intervention by nursing staff for the elevated temperature. The most frequently documented intervention was pharmacologic (358/1166 elevations). Other nursing actions (e.g. use of fan) accounted for a minority (<1%) of nursing interventions documented. Patients were more likely to have a high temperature that exceeded 40°C (13%) than a temperature that was normothermic (5%). There continues to be an under treatment of fever in patients with TBI by critical care nurses despite our knowledge of its negative effects on outcomes. There remains a gap in translation between patient outcomes research and bedside practice that needs to be overcome, thus research efforts need to now focus on understanding nurses' decision-making processes and the best methods of fever reduction in patients with TBI.

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“…[1][2][3] According to the severity of head trauma, patients can be grouped into mild TBI (in 30-91%), moderate TBI (in 4-30%) and severe TBI (in 5-40%) groups. [2,[4][5][6] Traumatic brain injury (TBI) patients are prevailingly male (58-74%). [1][2][3] However, females were 1.8 times more likely to die of their brain injury and 1.6 times more likely to experience poorer outcomes (that is, severe disability or persistent vegetative state) than males.…”

Section: Resultsmentioning

confidence: 99%