Critical care management of adult traumatic brain injury

Publication date: Available online 29 March 2017 Source:Anaesthesia & Intensive Care Medicine Author(s): Michael Puntis, Martin Smith Severe traumatic brain injury (TBI) is associated with significant morbidity and mortality. The critical care management of TBI requires a coordinated and comprehensive approach to treatment, including strategies to prevent secondary brain injury by avoidance of systemic physiological disturbances, such as hypotension, hypoxaemia, hypo- and hyperglycaemia and hyperthermia, and maintenance of adequate cerebral perfusion and oxygenation. Management protocols have evolved with international consensus, providing guidelines that assist clinicians in delivering optimal care. Those from the Brain Trauma Foundation are continuously updated to incorporate new trial data (https://braintrauma.org/coma/guidelines).
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research

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Editor ’s PerspectiveWhat We Already Know about This TopicCardiac output is an independent regulator of cerebral blood flow in healthy awake humansThe relationship between cardiac output and cerebral blood flow in anesthetized patients undergoing laparoscopy has not been previously characterizedWhat This Article Tells Us That Is NewAt steady-state depth of anesthesia, in patients undergoing laparoscopic cholecystectomy, creation of pneumoperitoneum decreased cardiac output and internal carotid artery blood flow while mean arterial pressure and end-tidal carbon dioxide levels remained unchangedBackground Little is kno...
Source: Anesthesiology - Category: Anesthesiology Source Type: research
Abstract The depth of anesthesia is commonly assessed in clinical practice by the patient's clinical signs. However, during cardiopulmonary bypass and hypothermia, common symptoms of nociception such as tachycardia, hypertension, sweating, or movement have low sensitivity and specificity in the description of the patient nociception and hypnosis, in particular, detecting nociceptive stimuli. Better monitoring of the depth of analgesia during hypothermia under cardiopulmonary bypass will avoid underdosage or overdosage of analgesia, especially opioids. Induced hypothermia has a multifactorial effect on the level of...
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
CARDIOGENIC SHOCK is a state of inadequate end-organ perfusion resulting from myriad causes, including ischemia, myocarditis, acute and chronic heart failure, postcardiotomy, and post-transplantation. It is the leading cause of death among patients experiencing acute myocardial infarction, with a mortality of 40% to 50%.1 Treatment generally includes revascularization for ischemia and supportive care with inotropes, vasopressors, and fluids as needed. Refractory cardiogenic shock is defined as ongoing hypoperfusion despite the administration of multiple vasoactive medications and treatment of the underlying cause.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Pro and Con Source Type: research
We present a patient who had recurrent subdural hematoma secondary to persistent undiagnosed CSF leak from the dural puncture site after uncomplicated placement and removal of a lumbar drain.
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports Source Type: research
Authors: Kuczeriszka M, Walkowska A, Olszynski KH, Rafalowska J, Sadowski J, Kompanowska-Jezierska E Abstract High salt (HS) intake can lead to hypertension, probably the result of the predominance of vasoconstrictor reactive oxygen species over vasodilator nitric oxide (NO). We aimed to examine if the supposed NO deficiency and the resultant blood pressure increase could be corrected by supplementation of L-arginine, the substrate, and tetrahydrobiopterin (BH4), a co-factor of NO synthases. Wistar rats without known genetic background of salt sensitivity were exposed to HS diet (4%Na) for 10 or 26 days, without or...
Source: Journal of Physiology and Pharmacology - Category: Drugs & Pharmacology Tags: J Physiol Pharmacol Source Type: research
CONCLUSION Selective aortic arch perfusion is effective in eliciting ROSC after HiTCA in a swine model, using either FWB or HBOC-201. Transition from SAAP to ECLS after definitive hemorrhage control is feasible, resulting in high overall survival and improvement in lactic acidosis over the study period.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - Category: Orthopaedics Tags: AAST 2018 PODIUM Source Type: research
Publication date: Available online 22 July 2019Source: Best Practice &Research Clinical AnaesthesiologyAuthor(s): Christian Schmidt, Astrid Ellen Berggreen, Matthias HeringlakeAbstractThe clinical usefulness of the so-called “static” cardiac filling pressures - central (CVP) and pulmonary-artery-occlusion-pressure (PAOP) – has come into question for guiding hemodynamic therapy due to their poor ability to predict fluid responsiveness in comparison with other monitoring modalities like transpulmonary thermodilution derived volumetric measurements, dynamic variables for assessing fluid responsiveness, a...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research
The search for safe and effective patient management strategies during weaning from cardiopulmonary bypass is ongoing; intravenous calcium is occasionally used as a first-line drug. The physiologic role of calcium suggests that it can support the function of the cardiovascular system during this critical period. Patients may be mildly hypocalcemic after cardiopulmonary bypass; however, this degree of hypocalcemia does not significantly impair the cardiovascular system. The transient beneficial effects of calcium administration (increase in arterial blood pressure, systemic vascular resistance, cardiac index, stroke volume,...
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Review Article Source Type: research
Intra-operative transcranial Doppler (TCD) is the gold standard for prediction of cerebral hyperperfusion syndrome (CHS) in patients after carotid endarterectomy (CEA) under general anaesthesia. However, post-operative cerebral perfusion patterns may result in a shift in risk assessment for CHS. This is a study of the predictive value of additional post-operative TCD measurements for prediction of CHS after CEA.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
Publication date: August 2019Source: Anaesthesia Critical Care &Pain Medicine, Volume 38, Issue 4Author(s): Thomas Geeraerts, Ségolène Mrozek, Clément Monet, Jean-Marc Olivot
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
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