Risk Factors Related to Dysautonomia After Severe Traumatic Brain Injury

Lv, Liquan; Hou, Lingling; Yu, Mei; Qi, Xiangqian; Chen, Huairui; Chen, Juxiang; Hu, Guohan; Luo, Chun; Lu, Youming

doi:10.1097/ta.0b013e31820ebee1

Cited by 36 publications

(42 citation statements)

References 21 publications

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“…69 Young age and diffuse axonal injury are risk factors for developing PSH. 70 There are no specific guidelines for managing PSH. The evidence for drug therapy is limited to case reports or case series, and includes opiates, GABA agonists, α- and β-blockers, and dopamine agonists with varying effectiveness.…”

Section: Management Of Complications and Other Neurocritical Care Issuesmentioning

confidence: 99%

Pathophysiology and Clinical Management of Moderate and Severe Traumatic Brain Injury in the ICU

Sheriff

Hinson

2015

Semin Neurol

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Moderate and severe traumatic brain injury (TBI) is the leading cause of morbidity and mortality among young individuals in high-income countries. Its pathophysiology is divided into two major phases: the initial neuronal injury (or primary injury) followed by secondary insults (secondary injury). Multimodality monitoring now offers neurointensivists the ability to monitor multiple physiologic parameters that act as surrogates of brain ischemia and hypoxia, the major driving forces behind secondary brain injury. The heterogeneity of the pathophysiology of TBI makes it necessary to take into consideration these interacting physiologic factors when recommending for or against any therapies; it may also account for the failure of all the neuroprotective therapies studied so far. In this review, the authors focus on neuroclinicians and neurointensivists, and discuss the developments in therapeutic strategies aimed at optimizing intracranial pressure and cerebral perfusion pressure, and minimizing cerebral hypoxia. The management of moderate to severe TBI in the intensive care unit is moving away from a pure “threshold-based” treatment approach toward consideration of patient-specific characteristics, including the state of cerebral autoregulation. The authors also include a concise discussion on the management of medical and neurologic complications peculiar to TBI as well as an overview of prognostication.

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Section: Management Of Complications and Other Neurocritical Care Issuesmentioning

confidence: 99%

Pathophysiology and Clinical Management of Moderate and Severe Traumatic Brain Injury in the ICU

Sheriff

Hinson

2015

Semin Neurol

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“…While research directly examining autonomic regulatory changes following concussion is limited, some support comes from the literature on severe traumatic brain injury (TBI). Significant changes in cardiac autonomic control after TBI have been reported, including parasympathetic withdrawal from the cardiac rhythm (resulting in severe cardiac abnormalities), orthostatic intolerance, and tachycardia [11,12]. …”

Section: Introductionmentioning

confidence: 99%

The Effect of Exertion on Heart Rate and Rating of Perceived Exertion in Acutely Concussed Individuals

Hinds¹,

Leddy

Freitas

et al. 2016

J Neurol Neurophysiol

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ObjectiveResearch suggests that one physiological effect of concussion is a disruption in regulation of autonomic nervous system control that affects the balance between parasympathetic and sympathetic output. While changes in heart rate after concussion have been observed, the nature of the heart rate change during progressive exercise has not been well evaluated in acutely symptomatic patients. Additionally, little is known about the relationship between HR and RPE in this population.MethodsWe compared changes in heart rate and perceived effort during graded treadmill exertion in recently concussed patients to elucidate the effect of brain injury on cardiovascular response to exercise. Resting HR, HR on exercise initiation, and changes in HR and RPE during the Buffalo Concussion Treadmill Test (BCTT) were compared on two test visits: When patients were symptomatic (acute) and after recovery. Results were compared with the test-retest results obtained from a control group consisting of healthy, non-concussed individuals.ResultsPatients had a significantly lower HR at onset of exercise when acutely concussed as compared to when recovered and reported greater perceived exertion at every exercise intensity level when symptomatic, despite exercising at lower workloads, than when recovered. Sympathetic response to increased exertion was not affected by concussion - HR increased in response to exercise at a comparable rate in both tests. These differences observed in response to exercise between the first BCTT and follow-up evaluation in initially concussed patients were not present in non-concussed individuals.ConclusionOur results suggest that during the acute phase after concussion, acutely concussed patients demonstrated an impaired ability to shift from parasympathetic to sympathetic control over heart rate at the onset of exercise. Changes in the autonomic nervous system after concussion may be more complex than previously reported. Continued evaluation of autonomic regulatory effects in the acute phase after concussion is warranted.

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“…PSH occurs in about 10% of sTBI patients[80–82], and is associated with younger age, more severe injury, early fever [83] and diffuse axonal injury [82, 84]. While recovery from the complication is possible, those with PSH generally have longer hospital and ICU stays, greater costs, and possibly worse outcomes [80, 85].…”

Section: Specific Strategies For Medical Managementmentioning

confidence: 99%

“…Several small, early-stage clinical trials [84–85] also suggested that acute progesterone administration may improve neurologic outcomes patients with sTBI [98]. Based on these findings, the efficacy of progesterone was recently studied in two Phase III trials.…”

Section: Pharmacologic Neuroprotective Strategiesmentioning

confidence: 99%

Medical Management of the Severe Traumatic Brain Injury Patient

et al. 2017

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Severe traumatic brain injury (sTBI) is a major contributor to long term disability and a leading cause of death worldwide. Medical management of the sTBI patient, beginning with pre-hospital triage, is aimed at preventing secondary brain injury. This review discusses prehospital and emergency department management of severe TBI, as well as aspects of TBI management in the intensive care unit where advances have been made in the past decade. Areas of emphasis include intracranial pressure management, neuromonitoring, management of paroxysmal sympathetic hyperactivity, neuroprotective strategies, prognostication, and communication with families about goals of care. Where appropriate, differences between the third and fourth editions of the Brain Trauma Foundation Guidelines for the Management of Severe Traumatic Brain Injury are highlighted.

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Risk Factors Related to Dysautonomia After Severe Traumatic Brain Injury

Abstract: Dysautonomia frequently occurs in patients with severe TBI. A younger age and DAI could be risk factors for facilitating the development of dysautonomia.

Cited by 36 publications

References 21 publications

Pathophysiology and Clinical Management of Moderate and Severe Traumatic Brain Injury in the ICU

Pathophysiology and Clinical Management of Moderate and Severe Traumatic Brain Injury in the ICU

The Effect of Exertion on Heart Rate and Rating of Perceived Exertion in Acutely Concussed Individuals

Medical Management of the Severe Traumatic Brain Injury Patient

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