Management of severe traumatic brain injury (first 24 hours)

Abstract

The latest French Guidelines for the management in the first 24hours of patients with severe traumatic brain injury (TBI) were published in 1998. Due to recent changes (intracerebral monitoring, cerebral perfusion pressure management, treatment of raised intracranial pressure), an update was required. Our objective has been to specify the significant developments since 1998. These guidelines were conducted by a group of experts for the French Society of Anesthesia and Intensive Care Medicine (Société francaise d'anesthésie et de réanimation [SFAR]) in partnership with the Association de neuro-anesthésie-réanimation de langue française (ANARLF), The French Society of Emergency Medicine (Société française de médecine d'urgence (SFMU), the Société française de neurochirurgie (SFN), the Groupe francophone de réanimation et d'urgences pédiatriques (GFRUP) and the Association des anesthésistes-réanimateurs pédiatriques d'expression française (ADARPEF). The method used to elaborate these guidelines was the Grade method. After two Delphi rounds, 32 recommendations were formally developed by the experts focusing on the evaluation the initial severity of traumatic brain injury, the modalities of prehospital management, imaging strategies, indications for neurosurgical interventions, sedation and analgesia, indications and modalities of cerebral monitoring, medical management of raised intracranial pressure, management of multiple trauma with severe traumatic brain injury, detection and prevention of post-traumatic epilepsia, biological homeostasis (osmolarity, glycaemia, adrenal axis) and paediatric specificities.

Automatic regulation of the endotracheal tube cuff pressure with a portable elastomeric device. A randomized controlled study

“…Second, the study was focused on the specific population of brain injured patients, and we mostly used one model of endotracheal tube. However, this population is of interest in the field of prevention of respiratory infections since it is prone to develop such infections because, among other reasons, prolonged median duration of mechanical ventilation [24,25]. We therefore believe that focusing on this specific population should be seen as strength rather than limitation of this study.…”

“…In the present study, using a three-way stopcock in both groups would have been helpful to delineate the specific contribution of the Tracoe Smart Cuff Manager™ and the three-way stopcock to our findings. However, adding a three-way stopcock to the endotracheal tube when no device for automated adjustment is connected is not recommended [24,25] and is therefore neither wide current practice nor part of our routine care.…”

Das Schädel-Hirn-Trauma: Wann konservativ, wann operativ therapieren?

“…Die Glasgow-Coma-Skala (GCS) und der sich aus dieser zu errechnende Summenwert ist Grundlage für die Beurteilung der Schwere des SHTs und damit Basis für initiale Managemententscheidungen sowohl am Unfallort als auch im Krankenhaus [2]. Hierbei wird bei einem Skalenwert von 3-8 von einem schweren SHT gesprochen; diese Patienten sind komatös.…”

“…Bei allen Patienten mit einem moderaten bis schweren SHT sowie bei Patienten mit einem milden SHT, bei denen der Unfallmechanismus und die Inspektion des Kopfes Hinweise auf eine umschriebene, aber tiefe Schädigung geben (z. B. Hammerschlag, Messerstich), ist eine Bildgebung mittels kranieller Computertomografie (CCT) unabdingbar [2]. Auf die Durchführung einer Röntgenaufnahme des Schädels hingegen sollte heutzutage verzichtet werden.…”

The Effects of Ademol on the Formation of Steroi D Neurotoxicity by the Level of Cortisol in Conditions of Modelal Current Brain Injury

“…Великі сподівання сучасної медицини на нейропротекторну терапію, стимулювали науковців всього світу на активний пошук нових ефективних засобів впливу на патофізіологічні каскади розвитку нейронального пошкодження [18]. Неоднозначність результатів клінічних випробувань по вивченню ефективності нейропротекторних впливів вплинула на те, що доцільність нейропротекторної терапії, на сьогоднішній день, залишається предметом гострих дискусій [10]. Говорячи про нейропротекцію, в першу чергу слід мати на увазі попередження і зменшення пошкодження нейронів, що мають чітке доказове обгрунтування, тобто підтверджені в експериментальних і рандомізованих клінічних дослідженнях [4,10,18].…”