Influence of prehospital treatment on the outcome of patients with severe blunt traumatic brain injury: a single-centre study

Berlot, Giorgio; Fata, Cristina La; Bacer, Barbara; Biancardi, Bruno; Viviani, Marino; Lucangelo, Umberto; Gobbato, Piero; Torelli, Lucio; Carchietti, Elio; Trillò, Giulio; Marrelli, Daniele; Rinaldi, Adriano

doi:10.1097/mej.0b013e32832d3aa1

Cited by 56 publications

(30 citation statements)

References 15 publications

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“…[14] The mean fluid volume of this sample is comparable to that administered to TBI patients in an international study (1 056 ml) who had a much lower incidence of hypotension (18%) at these volumes. [15] If the administered fluid volume was adequate, these patients might have benefited from the use of inotropes to improve their BP and cerebral perfusion pressure (CPP). However, the benefit of inotropes may be offset by the risk of hypertension and the potential for developing acute respiratory distress syndrome.…”

Section: Discussion Hypotensionmentioning

confidence: 99%

The prevalence of hypotension and hypoxaemia in blunt traumatic brain injury in the prehospital setting of Johannesburg, South Africa: A retrospective chart review

Stassen

Welzel

2014

S Afr Med J

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Section: Discussion Hypotensionmentioning

confidence: 99%

The prevalence of hypotension and hypoxaemia in blunt traumatic brain injury in the prehospital setting of Johannesburg, South Africa: A retrospective chart review

Stassen

Welzel

2014

S Afr Med J

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“…Physician-staffed pre-hospital services are becoming more prevalent throughout the world due to the potential to improve outcomes, particularly for the critically injured [19][20][21]. The inaccuracy of NIBP has been shown to persist out of hospital as well.…”

Section: Discussionmentioning

confidence: 99%

Comparison of non‐invasive and invasive blood pressure in aeromedical care

McMahon¹,

Hogg²,

Corfield³

et al. 2012

Anaesthesia

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SummaryBlood pressure measurement is an essential physiological measurement for all critically ill patients. Previous work has shown that non-invasive blood pressure is not an accurate reflection of invasive blood pressure measurement. In a transport environment, the effects of motion and vibration may make non-invasive blood pressure less accurate. Consecutive critically ill patients transported by a dedicated aeromedical retrieval and critical care transfer service with simultaneous invasive and non-invasive blood pressure measurements were analysed. Two sets of measurements were recorded, first in a hospital environment before departure (pre-flight) and a second during aeromedical transport (inflight). A total of 56 complete sets of data were analysed. Bland-Altman plots showed limits of agreement (precision) for pre-flight systolic blood pressure were )37.3 mmHg to 30.0 mmHg, and for pre-flight mean arterial pressure )20.5 mmHg to 25.0 mmHg. The limits of agreement for in-flight systolic blood pressure were )40.6 mmHg to 33.1 mmHg, while those for in-flight mean blood pressure in-flight were )23.6 mmHg to 24.6 mmHg. The bias for the four conditions ranged from 0.5 to )3.8 mmHg. There were no significant differences in values between pre-flight and in-flight blood pressure measurements for all categories of blood pressure measurement. Thus, our data show that noninvasive blood pressure is not a precise reflection of invasive intra-arterial blood pressure. Mean blood pressure measured non-invasively may be a better marker of invasive blood pressure than systolic blood pressure. Our data show no evidence of non-invasive blood pressures being less accurate in an aeromedical transport environment.

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“…Insbesondere die medikamentengestützte Narkoseeinleitung, adäquate Oxygenierung und Kreislauftherapie reduzieren bei bewusstseinsgetrübten Patienten (GCS 6-8) die Letalität [9,55]. Beim Polytrauma mit SHT gehört die Hypoxie neben der Hypotension zu den Hauptursachen für einen Sekundärschaden [17,18,51,88,91].…”

Section: Schweres Schädel-hirn-traumaunclassified

Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma

et al. 2011

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Patients with multiple trauma presenting with apnea or a gasping breathing pattern (respiratory rate <6/min) require prehospital endotracheal intubation (ETI) and ventilation. Additional indications are hypoxia (S(p)O(2)<90% despite oxygen insufflation and after exclusion of tension pneumothorax), severe traumatic brain injury [Glasgow Coma Scale (GCS)<9], trauma-associated hemodynamic instability [systolic blood pressure (SBP)<90 mmHg] and severe chest trauma with respiratory insufficiency (respiratory rate >29/min). The induction of anesthesia after preoxygenation is conducted as rapid sequence induction (analgesic, hypnotic drug, neuromuscular blocking agent). With the availability of ketamine as a viable alternative, the use of etomidate is not encouraged due to its side effects on adrenal function. An electrocardiogram (ECG), blood pressure measurement and pulse oximetry are needed to monitor the emergency anesthesia and the secured airway. Capnography is absolutely mandatory to confirm correct placement of the endotracheal tube and to monitor tube dislocations as well as ventilation and oxygenation in the prehospital and hospital setting. Because airway management is often complicated in trauma patients, alternative devices and a fiber-optic endoscope need to be available within the hospital. Use of these alternative measures for airway management and ventilation should be considered at the latest after a maximum of three unsuccessful intubation attempts. Emergency medical service (EMS) physicians should to be trained in emergency anesthesia, ETI and alternative methods of airway management on a regular basis. Within hospitals ETI, emergency anesthesia and ventilation are to be conducted by trained and experienced anesthesiologists. When a difficult airway or induction of anesthesia is expected, endotracheal intubation should be supervised or conducted by an anesthesiologist. Normoventilation should be the goal of mechanical ventilation. After arrival in the resuscitation room the ventilation will be controlled and guided with the help of arterial blood gas analyses. After temporary removal of a cervical collar, the cervical spine needs to be immobilized by means of manual in-line stabilization when securing the airway.

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Influence of prehospital treatment on the outcome of patients with severe blunt traumatic brain injury: a single-centre study

Cited by 56 publications

References 15 publications

The prevalence of hypotension and hypoxaemia in blunt traumatic brain injury in the prehospital setting of Johannesburg, South Africa: A retrospective chart review

The prevalence of hypotension and hypoxaemia in blunt traumatic brain injury in the prehospital setting of Johannesburg, South Africa: A retrospective chart review

Comparison of non‐invasive and invasive blood pressure in aeromedical care

Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma

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