Management of Traumatic Brain Injury

Davanzo, Justin R.; Sieg, Emily; Timmons, Shelly D.

doi:10.1016/j.suc.2017.08.001

Cited by 29 publications

(19 citation statements)

References 64 publications

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“…Intracranial hypertension and cerebral hypoperfusion can be understood as secondary insults after TBI and their prevention or mitigation are critical for the management of these patients [11]. Numerous studies have consistently shown that early recognition and treatment of these complications lead to better outcomes [12]. Our study sought to evaluate the association between ICP elevation and serum inflammation biomarkers variation, such as cytokines.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory markers assessment in an animal model of intracranial hypertension: a randomized trial

Santo

Faria

Solla

et al. 2021

ICMx

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Background Intracranial hypertension (ICH) is a common final pathway of most neurosurgical pathologies and leads to poor prognosis if not detected and treated properly. Inflammatory markers have been assessed in clinical scenarios of neurological injuries, in which systemic and brain tissue aggressions may introduce bias. There is a lack of studies under controlled settings to isolate the ICH effect on inflammation. This study aims to evaluate the effects of ICH on the serum concentration of cytokines as biomarkers of neuroinflammation in an experimental model which isolates ICH from potential confounding variables. Methods An established model of ICH using an intracerebral pediatric bladder catheter and a multisensor intraparenchymal catheter was used in adult pigs (Sus domesticus). The animals were randomly allocated to 2 groups based on the catheter balloon volume used to simulate the ICP increase (4 ml or 7 ml). Cytokines were measured in 4 timepoints during the experiment: (1) 15 min before balloon insufflation; (2) 5 min after insufflation; (3) 125 min after insufflation; (4) 60 min after deflation. The following cytokines were measured IL-1α; IL-1β; IL–1ra; IL-2; IL-4; IL-6; IL-8; IL-10; IL-12; IL-18; TNFα. Generalized estimating equations were modeled to compare the ICP and cytokines values between the groups along the experiment. The study sample size was powered to detect interactions between the groups and the study moments with an effect size (f) of at least 0.3. The ARRIVE checklist was followed. Results A total of 20 animals were studied (10 in each group, 4 ml or 7 ml balloon volume insufflation). The animal model was successful in increasing the ICP along the moments of the experiment (p < 0,001) and in creating an ICP gradient between the groups (p = 0,004). The interaction term (moment × group) was also significant (p < 0,001). There was a significant association between ICP elevation and most cytokines variation. The cytokines IL-1α, IL-1β, IL1-ra, IL-6, IL-12, and IL-18 increased, whereas IL-2, IL-4, and TNF-α decreased. IL-10 did not vary significantly in response to the ICP elevation. Conclusion The serum concentration of cytokines varied in response to intracranial hypertension. The study demonstrated the specific changes in each cytokine after intracranial hypertension and provides key information to guide neuroinflammation clinical research. The proposed experiment was successful as an animal model to the study of neuroinflammation biomarkers

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Section: Discussionmentioning

confidence: 99%

Inflammatory markers assessment in an animal model of intracranial hypertension: a randomized trial

Santo

Faria

Solla

et al. 2021

ICMx

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“…8 This condition encompasses an interesting spectrum that should not only consider its immediate consequences but also assess the long-term impact, especially those of working age. 11 The classification of the severity of the TBI is based on the clinical status, using the GCS, 10 knowing that a patient with mild TBI is (GCS 13-15), moderate (GCS 9-12), or severe (GCS ≤8). 10 Although it is not an exhaustive examination instrument, the GCS contributes together with other biological to frame the degree of injury product of the traumatic event factors, thereby providing diagnostic and prognostic information.…”

Section: Clinical Examination and Clinical Classification Of Tbimentioning

confidence: 99%

Critical Appraisal of Traumatic Brain Injury and Its Management

Konar

Pavlov

Durango-Espinosa

et al. 2020

Indian Journal of Neurotrauma

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Critical appraisal of traumatic brain injury (TBI) management has always been marred with a conflict of differential approaches, with claims and counterclaims of outcomes among the research groups. We performed this study to review the management of TBI from risk factors to outcomes including the comorbidities and final clinical status. In conjunction with the aforesaid stabilization of TBI cases, prophylactic and definitive surgical approaches and other supporting interventions will ultimately decide the final outcomes in the long run. Improvements in the quality of care for patients with severe TBI, with the reduction in mortality, have been demonstrated in high-income areas due to improvements in the health care system and not just in one isolated intervention. In the management of TBI, a fast and high index of suspicion is the key to success, from the initial assessment to the final rehabilitation of the cases, from the victim of risk factors to the victims of situation. The research groups feel that TBI prophylactic measures and primary care mitigation models are as important as definitive care, starting from prehospital care to dedicated care.

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“…shaking a baby). Most of these injuries are preventable (Davanzo 2017), and prevention measures do exist. These include the use of technology -such as seat belts and sportsor motorcycle helmets -to protect a person during a crash, as well as e orts to reduce the number of motor vehicle crashes through safety education programmes and enforcement of tra ic laws (Reilly 2007).…”

Section: Description Of the Conditionmentioning

confidence: 99%