Pragmatic sedation strategies to prevent secondary brain injury in low‐resource settings

Abstract

Summary Traumatic brain injury is the alteration in brain function due to an external force. It is common and affects millions of people worldwide annually. The World Health Organization estimates that 90% of global deaths caused by injuries occur in low‐ and middle‐income countries, with traumatic brain injury contributing up to half of these trauma‐related deaths. Patients with traumatic brain injury in low‐ and middle‐income countries have twice the odds of dying compared with their counterparts in high‐income countries. Sedation is a key element of care in the management of traumatic brain injury, used for its neuroprotective effects and to prevent secondary brain injury. While sedatives have the potential to improve outcomes, they can be challenging to administer and have potentially dangerous complications. Sedation in low‐resource settings should aim to be effective, safe, affordable and feasible. In this paper, we summarise the indications for sedation in traumatic brain injury, the choice of sedative drugs and the pragmatic management and monitoring of sedated traumatic brain injury patients in low‐resource settings.

Local Delivery of Dual Stem Cell-Derived Exosomes Using an Electrospun Nanofibrous Platform for the Treatment of Traumatic Brain Injury

“…While data from the United States and New Zealand estimate an annual incidence of 500–800 cases per 100 000 population, comprehensive epidemiological data for China have remained elusive for three decades. Nonetheless, large-scale, population-based studies suggest an estimated 770 060–890 990 new TBI cases annually in China. − TBI is primarily induced by external mechanical forces or penetrating objects, leading to a cascade of pathological events that transition from primary to secondary injuries. This progression is underscored by a complex pathogenesis involving sustained inflammation and neurodegeneration. − Despite advancements in surgical interventions and postoperative care, the therapeutic paradigm for TBI lacks ideal pharmacological agents, and the prognosis remains suboptimal .…”

Association of Early Dexmedetomidine Utilization With Clinical Outcomes After Moderate-Severe Traumatic Brain Injury: A Retrospective Cohort Study

“…Sedative choice therefore represents a potential modifiable factor to improve patient care 10 and reduce clinical practice variation in this population. 11 Among sedatives, dexmedetomidine has emerged as a potential candidate for patients with msTBI. A member of the pharmacologic class of selective α 2 agonists, dexmedetomidine reduces sympathetic outflow from the nucleus coeruleus.…”

“…Sedative choice therefore represents a potential modifiable factor to improve patient care 10 and reduce clinical practice variation in this population. 11…”