Refractory intracranial hypertension and “second-tier” therapies in traumatic brain injury

Abstract

HICP is frequent and is associated with worse outcome. ICP was controlled by early surgery and first-tier therapies in the majority of cases. Profound hyperventilation, surgical decompression and barbiturates were used in various combinations in a minority of cases. The indications for surgical decompression and/or barbiturates seem restricted to less than 10% of severe TBI.

Glasgow outcome scale at hospital discharge as a prognostic index in patients with severe traumatic brain injury

“…In this way, the Glasgow outcome scale (GOS), described by Jennett and Bond 9 in 1975, has been extensively employed to outcome evaluation of TBI patients take into consideration their physical, social and cognitive sequelae [10][11][12][13] . Despite some controversies regarding GOS reliability, it is widespread used to evaluate long-term outcome of severe brain injured patients 14 .…”

A Practical Approach to Interpretation of CBF Measured by Mean of Xenon-CT in Patients with Traumatic Brain Injury

“…It seems, therefore that basic clinical information can only partially explain and predict global CBF values, suggesting that additional variables should be investigated, although our potential to understand global CBF is still limited. Further, while only barbiturates seem to affect CBF in multivariate analysis, it is unclear, however, whether increasing the dosage would result in further CBF reduction [95,99]. In fact, such a hypothesis is not supported by our data showing that CBF is not significantly lower in more intensely treated patients, which may be a consequence of uncoupling from oxygen metabolism (Fig.…”

Prх-monitoring based decision-making about decompressive craniectomy in a patient with severe traumatic brain injury. A case report

“…[18,19]. Барбитураты на сегодняшний день рассматриваются как последняя ступень агрес-сивной терапии ВЧГ, и их использование не улуч-шает исходы при ЧМТ [1,4,6,7,16,17].…”

“…[1,4,5]. Основным механизмом дей-ствия декомпрессии является создание дополни-тельного пространства для компенсации увеличен-ного внутричерепного объема [6][7][8]11]. Считается, что эффективность декомпрессии зависит от разме-ра декомпрессионного окна [9][10][11].…”