Traumatic Brain Swelling and Operative Decompression: A Prospective Investigation

Gaab, M. R.; Rittierodt, Marion; Lorenz, Martin; Heissler, Hans E.

doi:10.1007/978-3-7091-9115-6_110

Cited by 64 publications

(59 citation statements)

References 2 publications

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“…Reduction of refractory ICP has been shown to be a major predictor of mortality following TBI, 21,25,31,42 and many studies have confirmed the positive effects of craniectomy on reducing ICP following TBI. 1,37,49,50 However, few randomized controlled studies exist that specifically address the effectiveness of craniectomy in pediatric populations to improve clinical outcome.…”

Section: Surgical Interventions For Tbi In the Pediatric Populationmentioning

confidence: 99%

“…Because ICP following TBI is widely regarded as an important physiological determinant of brain function and clinical outcome, 21,25,30,42 many approaches have been developed to control ICP. However, despite the existence of guidelines for management following TBI, there is a lack of data surrounding specific interventions, especially in pediatric populations.…”

Section: Surgical Interventions For Tbi In the Pediatric Populationmentioning

confidence: 99%

“…In both children and adults, a bilateral frontotemporoparietal craniectomy is often used for diffuse bilateral swelling, while a unilateral frontotemporoparietal craniectomy is chosen for unilateral brain swelling. 21,25,30 A variety of specialized techniques have also been reported in children, including smaller, 4-cm bitemporal craniectomies, 48 larger craniectomies, 25,28 and craniectomy combined with expansion duraplasty. 14,18,42 To date no study has compared the efficacy of the various techniques in improving outcome.…”

Section: Surgical Interventions For Tbi In the Pediatric Populationmentioning

confidence: 99%

“…21,25,30,42 Control of ICP is therefore crucial in preventing secondary injury. Healthy adults normally maintain ICP values below 20-25 mm Hg, although this exact threshold is not clear in any age group.…”

mentioning

confidence: 99%

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Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Appelboom

Zoller

Piazza

et al. 2011

FOC

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Traumatic brain injury (TBI) is the current leading cause of death in children over 1 year of age. Adequate management and care of pediatric patients is critical to ensure the best functional outcome in this population. In their controversial trial, Cooper et al. concluded that decompressive craniectomy following TBI did not improve clinical outcome of the analyzed adult population. While the study did not target pediatric populations, the results do raise important and timely clinical questions regarding the effectiveness of decompressive surgery in pediatric patients. There is still a paucity of evidence regarding the effectiveness of this therapy in a pediatric population, and there is an especially noticeable knowledge gap surrounding age-stratified interventions in pediatric trauma. The purposes of this review are to first explore the anatomical variations between pediatric and adult populations in the setting of TBI. Second, the authors assess how these differences between adult and pediatric populations could translate into differences in the impact of decompressive surgery following TBI.

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Section: Surgical Interventions For Tbi In the Pediatric Populationmentioning

confidence: 99%

Section: Surgical Interventions For Tbi In the Pediatric Populationmentioning

confidence: 99%

Section: Surgical Interventions For Tbi In the Pediatric Populationmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Appelboom

Zoller

Piazza

et al. 2011

FOC

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“…It allows the brain to swell, without further ICP increasing. It has been used lately in intracranial hypertension refractory to other treatments [138]. The technique carries with it a high mortality that, in part, can be attributed to several secondary injuries previously suffered by the patients.…”

Section: Box 2 Management Of the Traumatic Brain Injury Patientmentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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Decompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury

Sahuquillo

Dennis

2019

Cochrane Database of Systematic Reviews

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Traumatic Brain Swelling and Operative Decompression: A Prospective Investigation

Cited by 64 publications

References 2 publications

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Critical Care Issues in the Early Management of Severe Trauma

Decompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury

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