Prise en charge des traumatisés crâniens graves à la phase précoce (24 premières heures)

Geeraerts, Thomas; Velly, Lionel; Abdennour, Lamine; Asehnoune, Karim; Audibert, Gérard; Bouzat, Pierre; Bruder, Nicolas; Carrillon, Romain; Cottenceau, Vincent; Cotton, François; Courtil-Teyssedre, Sonia; Dahyot‐Fizelier, Claire; Dailler, Frédéric; David, Jean-Stéphane; Engrand, Nicolas; Fletcher, Dominique; Francony, Gilles; Gergelé, Laurent; Ichai, Carole; Javouhey, Étienne; Leblanc, Pierre-Étienne; Lieutaud, Thomas; Meyer, Philippe; Mirek, Sébastien; Orliaguet, Gilles; Proust, F.; Quintard, Hervé; Ract, Catherine; Srairi, Mohamed; Tazarourte, Karim; Vigué, Bernard; Payen, Jean‐François

doi:10.1016/j.anrea.2016.09.007

Cited by 7 publications

(5 citation statements)

References 276 publications

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“…Head injury patients were collected and transported by private vehicles or public transport, exposing patients to the risk of secondary injuries. According to the recommendations of the French Society of Anaesthesia and Intensive Care (SFAR) 2016 [19], a serious cranioencephalic trauma patient must be cared for by a pre-hospital medical team, regulated by the Emergency Medical Service (SAMU), and referred as soon as possible to a specialised centre including, in particular, a neurosurgical technical platform and an intensive care unit. This initial treatment aims to stabilise vital functions and avoid secondary cerebral attacks of systemic origin.…”

Section: Discussionmentioning

confidence: 99%

Management of Traumatic Brain Injuries at the Kara Regional Hospital

Dossouvi,

Towoezim,

Moumouni

et al. 2024

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Introduction: Traumatic Brain Injury (TBI) is a major public health problem causing significant morbidity and mortality in young adults. This study aimed to describe the epidemiological, diagnostic, therapeutic, and evolutionary aspects of TBI. Materials and Methods: This was a prospective, descriptive study conducted from 1 April 2022 to 31 March 2023 on patients admitted to and treated for cranioencephalic trauma in the General Surgery department of Kara Regional Hospital. Results: Eighty-three (83) patients with cranioencephalic trauma were managed out of 773 patients admitted to the department during the study period. The mean age was 34 ± 14.98 years and the sex ratio was 3.6 in favour of men. Motorbike taxi drivers were the social group most affected (n = 33, 40%). The causes of trauma were dominated by public road accidents (n = 80; 96%). TBI was mild (n = 40; 48%), moderate (n = 35; 42%) and severe (n = 8; 10%). Cerebral CT scans were performed in 19 patients (23%). Cerebral contusion (n = 4) was the most frequent cerebral lesion. Six patients (7%) with severe head injuries were transferred to Kara University Hospital. Six deaths (7%) occurred in patients with severe head injuries. The main sequelae were intermittent headaches in all patients reviewed, and memory problems (6%). Conclusion: Traumatic brain injuries are common at Kara Regional Hospital. Severe cranial trauma is less frequent but leads to death because of financial difficulties and limited technical facilities.

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Section: Discussionmentioning

confidence: 99%

Management of Traumatic Brain Injuries at the Kara Regional Hospital

Dossouvi,

Towoezim,

Moumouni

et al. 2024

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“…In such case, neuroresuscitation guidelines recommend to maintain the SBP >110 mmHg even if it may sustain extracranial bleeding, [ 53 ] the SpO 2 ≥96, the PaCO 2 between 30 and 35 mmHg, the body temperature between 35 and 37 Celsius degrees, and blood sugar level between 8 and 10 mmol/L to limit the occurrence of secondary brain insults. [ 54 ] On the same way, the platelet count should be maintained >50 G/L in STP, and >100 G/L in case of life-threatening hemorrhage or sTBI, and the fibrinogen level >1.5–2 g/L. [ 55 ]…”

Section: Discussionmentioning

confidence: 99%

“…Guidelines recommend the use of an invasive ICP monitor in case of sTBI (GCS ≤8) with non-operative brain lesions on the CT scan or after cranial surgery in STP and to maintain a CPP between 60 and 70 mmHg. [ 19 , 54 , 63 ] For this purpose, an EVD should be preferred because it allows both the surveillance of ICP and CSF drainage in case of ICH. [ 47 , 63 ]…”

Section: Discussionmentioning

confidence: 99%

Severe trauma patients requiring undelayable combined cranial and extracranial surgery: A scoping review of an emerging concept

Beucler

Sellier

Joubert

et al. 2022

JNRP

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Objectives: Although patients suffering from severe traumatic brain injury (sTBI) and severe trauma patients (STP) have been extensively studied separately, there is scarce evidence concerning STP with concomitant sTBI. In particular, there are no guidelines regarding the emergency surgical management of patients presenting a concomitant life-threatening intracranial hematoma (ICH) and a life-threatening non-compressible extra-cranial hemorrhage (NCEH). Materials and Methods: A scoping review was conducted on Medline database from inception to September 2021. Results: The review yielded 138 articles among which 10 were retained in the quantitative analysis for a total of 2086 patients. Seven hundrer and eighty-seven patients presented concomitant sTBI and extra-cranial severe injuries. The mean age was 38.2 years-old and the male to female sex ratio was 2.8/1. Regarding the patients with concomitant cranial and extra-cranial injuries, the mean ISS was 32.1, and the mean AIS per organ were 4.0 for the head, 3.3 for the thorax, 2.9 for the abdomen and 2.7 for extremity. This review highlighted the following concepts: emergency peripheric osteosynthesis can be safely performed in patients with concomitant sTBI (grade C). Invasive intracranial pressure monitoring is mandatory during extra-cranial surgery in patients with sTBI (grade C). The outcome of STP with concomitant sTBI mainly depends on the seriousness of sTBI, independently from the presence of extra-cranial injuries (grade C). After exclusion of early-hospital mortality, the impact of extra-cranial injuries on mortality in patients with concomitant sTBI is uncertain (grade C). There are no recommendations regarding the combined surgical management of patients with concomitant ICH and NCEH (grade D). Conclusion: This review revealed the lack of evidence for the emergency surgical management of patients with concomitant ICH and NCEH. Hence, we introduce the concept of combined cranial and extra-cranial surgery. This damage-control surgical strategy aims to reduce the time spent with intracranial hypertension and to hasten the admission in the intensive care unit. Further studies are required to validate this concept in clinical practice.

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“…SSRF to preserve or repair respiratory mechanics in polytrauma patients may, therefore, be a way to breach this vicious circle. But TBI treatment in polytrauma patients is a particular challenge for trauma surgeons and emergency physicians alike due to the imminent multifactorial risk of secondary brain injury and the tight time frame to avert additional brain injury and to improve patient prognosis [17][18][19]. Therefore, precipitative SSRF in polytrauma management may represent a preventable 'second hit' that aggravates patient recovery and prognosis [20,21].…”

Section: Introductionmentioning

confidence: 99%

Surgical stabilization of serial rib fractures is advantageous in patients with relevant traumatic brain injury

Freitag

Bechmann

Eden³

et al. 2022

Eur J Trauma Emerg Surg

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Purpose To evaluate the clinical benefit of surgical stabilization of rib fractures (SSRF) in polytrauma patients with serial rib fractures. Methods Retrospective single-center cohort analysis in trauma patients. Serial rib fracture was defined as three consecutive ribs confirmed by chest computer tomography (CT). Study cohort includes 243 patients that were treated conservatively and 34 patients that underwent SSRF. Demographic patient data, trauma mechanism, injury pattern, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) and hospital course were analyzed. Two matched pair analyses stratified for ISS (32 pairs) and GCS (25 pairs) were performed. Results The majority of patients was male (74%) and aged 55 ± 20 years. Serial rib fractures were associated with more than 6 broken ribs in average (6.3 ± 3.7). Other thoracic bone injury included sternum (18%), scapula (16%) and clavicula (13%). Visceral injury consisted of pneumothorax (51%), lung contusion (33%) and diaphragmatic rupture (2%). Average ISS was 22 ± 7.3. Overall hospital stay was 15.9 and ICU stay 7.4 days. In hospital, mortality was 13%. SSRF did not improve hospital course or postoperative complications in the complete study cohort. However, patients with a significantly reduced GCS (7.6 ± 5.3 vs 11.22 ± 4.8; p = 0.006) benefitted from SSRF. Matched pair analysis stratified for GCS showed shorter ICU stays (9 vs 15 days; p = 0.005) including shorter respirator time (143 vs 305 h; p = 0.003). Conclusion Patients with serial rib fractures and simultaneous moderate or severe traumatic brain injury benefit from surgical stabilization of rib fractures.

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Prise en charge des traumatisés crâniens graves à la phase précoce (24 premières heures)

Cited by 7 publications

References 276 publications

Management of Traumatic Brain Injuries at the Kara Regional Hospital

Management of Traumatic Brain Injuries at the Kara Regional Hospital

Severe trauma patients requiring undelayable combined cranial and extracranial surgery: A scoping review of an emerging concept

Surgical stabilization of serial rib fractures is advantageous in patients with relevant traumatic brain injury

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