The Monitoring and Management of Severe Traumatic Brain Injury in the United Kingdom

Wijayatilake, Dhuleep S.; Talati, Chiraag; Panchatsharam, Selvakumar

doi:10.1097/ana.0000000000000143

Cited by 19 publications

(12 citation statements)

References 22 publications

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“…All these techniques generally provide indirect information about pathological processes with several limitations [72,73]. However, they have been used rarely, even in the most specialized neurological ICUs [74].…”

Section: Multimodal Monitoring and Treatment Of Patients With Modementioning

confidence: 99%

Intensive Care in Traumatic Brain Injury Including Multi-Modal Monitoring and Neuroprotection

Stocker

2019

Medical Sciences

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Moderate to severe traumatic brain injuries (TBI) require treatment in an intensive care unit (ICU) in close collaboration of a multidisciplinary team consisting of different medical specialists such as intensivists, neurosurgeons, neurologists, as well as ICU nurses, physiotherapists, and ergo-/logotherapists. Major goals include all measurements to prevent secondary brain injury due to secondary brain insults and to optimize frame conditions for recovery and early rehabilitation. The distinction between moderate and severe is frequently done based on the Glascow Coma Scale and therefore often is just a snapshot at the early time of assessment. Due to its pathophysiological pathways, an initially as moderate classified TBI may need the same sophisticated surveillance, monitoring, and treatment as a severe form or might even progress to a severe and difficult to treat affection. As traumatic brain injury is rather a syndrome comprising a range of different affections to the brain and as, e.g., age-related comorbidities and treatments additionally may have a great impact, individual and tailored treatment approaches based on monitoring and findings in imaging and respecting pre-injury comorbidities and their therapies are warranted.

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Section: Multimodal Monitoring and Treatment Of Patients With Modementioning

confidence: 99%

Intensive Care in Traumatic Brain Injury Including Multi-Modal Monitoring and Neuroprotection

Stocker

2019

Medical Sciences

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“…Barriers to the widespread implementation of CMD are numerous, including costs, human resources, and the complexity of the technique (especially with respect to 100 kDa catheters) ( 1 ). These barriers may explain why CMD monitoring is still not in use in the majority of centers, as judged by a recent National survey on multimodal monitoring conducted in the UK ( 116 ). Recent consensus guidelines for the use of CMD in acute brain pathologies ( 2 , 15 ) and the increased application of CMD in other acute contexts, e.g., anoxic-ischemic ( 117 ) or hepatic encephalopathy ( 118 ), may contribute to a broader implementation of this technique.…”

Section: Implementation In the Intensive Care Unitmentioning

confidence: 99%

Cerebral Microdialysis Monitoring to Improve Individualized Neurointensive Care Therapy: An Update of Recent Clinical Data

Carteron¹,

Bouzat

Oddo

2017

Front. Neurol.

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Cerebral microdialysis (CMD) allows bedside semicontinuous monitoring of patient brain extracellular fluid. Clinical indications of CMD monitoring are focused on the management of secondary cerebral and systemic insults in acute brain injury (ABI) patients [mainly, traumatic brain injury (TBI), subarachnoid hemorrhage, and intracerebral hemorrhage (ICH)], specifically to tailor several routine interventions—such as optimization of cerebral perfusion pressure, blood transfusion, glycemic control and oxygen therapy—in the individual patient. Using CMD as clinical research tool has greatly contributed to identify and better understand important post-injury mechanisms—such as energy dysfunction, posttraumatic glycolysis, post-aneurysmal early brain injury, cortical spreading depressions, and subclinical seizures. Main CMD metabolites (namely, lactate/pyruvate ratio, and glucose) can be used to monitor the brain response to specific interventions, to assess the extent of injury, and to inform about prognosis. Recent consensus statements have provided guidelines and recommendations for CMD monitoring in neurocritical care. Here, we summarize recent clinical investigation conducted in ABI patients, specifically focusing on the role of CMD to guide individualized intensive care therapy and to improve our understanding of the complex disease mechanisms occurring in the immediate phase following ABI. Promising brain biomarkers will also be described.

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“…6 Finally, recent practice surveys suggest that these two options are equally commonly used. 7,8 Given the lack of evidence-supported options for severe ICH, it seems logical to focus research on the optimal choice of osmotherapy. In particular, it is now important to assess the epidemiology of modern osmotherapy use, including the choice of agent, the volume and timing of administration (especially in the early phase of ICH), and any association between choice of agent and mortality.…”

Section: Introductionmentioning

confidence: 99%

Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter Study

Anstey

Taccone

Udy

et al. 2020

Journal of Neurotrauma

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The optimal osmotic agent to treat intracranial hypertension in patients with severe traumatic brain injury (TBI) remains uncertain. We aimed to test whether the choice of mannitol or hypertonic saline (HTS) as early (first 96 h) osmotherapy in these patients might be associated with a difference in mortality. We retrospectively analyzed data from 2015 from 14 tertiary intensive care units (ICUs) in Australia, UK, and Europe treating severe TBI patients with intracranial pressure (ICP) monitoring and compared mortality in those who received mannitol only versus HTS only. We performed multivariable analysis adjusting for site and illness severity (Injury Severity Score, extended IMPACT score, and mean ICP over the first 96 h) using Cox proportional hazards regression. We collected data on 262 patients and compared patients who received early osmotherapy with mannitol alone (n = 46) with those who received HTS alone (n = 46). Mannitol patients were older (median age, 49.2 (19.2) vs. 40.5 (16.8) years; p = 0.02), with higher Injury Severity Scores (42 (15.9) vs. 32.1 [11.3]; p = 0.001), and IMPACT-TBI predicted 6-month mortality (34.5% [23-46] vs. 25% [13-38]; p = 0.02), but had similar APACHE-II scores, and mean and maximum ICPs over the first 96 h. The unadjusted hazard ratio for inhospital mortality in patients receiving only mannitol was 3.35 (95% confidence interval [CI], 1.60-7.03; p = 0.001). After adjustment for key mortality predictors, the hazard ratio for in-hospital mortality in patients receiving only mannitol was 2.64 (95% CI, 0.96-7.30; p = 0.06). The choice of early osmotherapy in severe TBI patients may affect survival, or simply reflect clinician beliefs about their different roles, and warrants controlled investigation.

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The Monitoring and Management of Severe Traumatic Brain Injury in the United Kingdom

Cited by 19 publications

References 22 publications

Intensive Care in Traumatic Brain Injury Including Multi-Modal Monitoring and Neuroprotection

Intensive Care in Traumatic Brain Injury Including Multi-Modal Monitoring and Neuroprotection

Cerebral Microdialysis Monitoring to Improve Individualized Neurointensive Care Therapy: An Update of Recent Clinical Data

Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter Study

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