1
|
Delteil C, Manlius T, Bailly N, Godio-Raboutet Y, Piercecchi-Marti MD, Tuchtan L, Hak JF, Velly L, Simeone P, Thollon L. Traumatic axonal injury: Clinic, forensic and biomechanics perspectives. Leg Med (Tokyo) 2024; 70:102465. [PMID: 38838409 DOI: 10.1016/j.legalmed.2024.102465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/21/2024] [Accepted: 06/01/2024] [Indexed: 06/07/2024]
Abstract
Identification of Traumatic axonal injury (TAI) is critical in clinical practice, particularly in terms of long-term prognosis, but also for medico-legal issues, to verify whether the death or the after-effects were attributable to trauma. Multidisciplinary approaches are an undeniable asset when it comes to solving these problems. The aim of this work is therefore to list the different techniques needed to identify axonal lesions and to understand the lesion mechanisms involved in their formation. Imaging can be used to assess the consequences of trauma, to identify indirect signs of TAI, to explain the patient's initial symptoms and even to assess the patient's prognosis. Three-dimensional reconstructions of the skull can highlight fractures suggestive of trauma. Microscopic and immunohistochemical techniques are currently considered as the most reliable tools for the early identification of TAI following trauma. Finite element models use mechanical equations to predict biomechanical parameters, such as tissue stresses and strains in the brain, when subjected to external forces, such as violent impacts to the head. These parameters, which are difficult to measure experimentally, are then used to predict the risk of injury. The integration of imaging data with finite element models allows researchers to create realistic and personalized computational models by incorporating actual geometry and properties obtained from imaging techniques. The personalization of these models makes their forensic approach particularly interesting.
Collapse
Affiliation(s)
- Clémence Delteil
- Forensic Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Thais Manlius
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.
| | - Nicolas Bailly
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France; Neuroimagery Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France.
| | | | - Marie-Dominique Piercecchi-Marti
- Forensic Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Lucile Tuchtan
- Forensic Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | | | - Lionel Velly
- Département d'Anesthésie-Réanimation, Assistance Publique-Hôpitaux de Marseille, La Timone, Marseille, France; Université Aix-Marseille/CNRS, Institut des Neurosciences de la Timone, UMR7289, Marseille, France.
| | - Pierre Simeone
- Département d'Anesthésie-Réanimation, Assistance Publique-Hôpitaux de Marseille, La Timone, Marseille, France; Université Aix-Marseille/CNRS, Institut des Neurosciences de la Timone, UMR7289, Marseille, France.
| | - Lionel Thollon
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.
| |
Collapse
|
2
|
Arlt K, Frank P, Flentje M, Eismann H, Hermann EJ, Krauss JK, Al-Afif S, Palmaers T. Effect of mannitol on platelet function during elective craniotomy in adult patients with brain tumor. J Neurosurg Sci 2024; 68:447-452. [PMID: 35380206 DOI: 10.23736/s0390-5616.22.05678-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Mannitol is used in the treatment of raised intracranial pressure (ICP). The aim of this study was to investigate whether mannitol (MAN) leads to a relevant deterioration in platelet function in routine neurosurgical procedures. METHODS Thirty-eight patients undergoing elective craniotomy due to a brain tumor with elevated ICP were included. After induction of anesthesia a blood sample was taken (T1). The patients then received 1 g∙kg-1 MAN within 30 minutes. The second blood sample (T2) was obtained 60 minutes after T1. Blood samples were examined by means of aggregometry (Multiplate®; Roche, Basel, Switzertland) and PFA-100® tests (Siemens Healthineers, Erlangen, Germany). RESULTS No patient had clinical signs of increased bleeding. We could not find any deterioration in the aggregometry using Multiplate® (Roche), neither in the adenosine diphosphate (ADP), the arachidonic acid (ASPI), or the thrombin receptor activating protein (TRAP) test. PFA-100® (Siemens Healthineers) closing times (cT) showed a significant prolongation between T1 and T2: collagen/adenosine diphosphate (COL/ADP) test 79 s [70/99] and 91 s [81/109]; P=0.002); collagen/epinephrine (COL/EPI) test 109 s [92/129] and 122 s [94/159]; P=0.0004). A subgroup analysis showed that the patients who received isotonic balanced infusions only, had no prolongation of cT, whereas the patients who received additionally gelatin solution had a significant prolongation. COL/ADP: 78 s [70/98] and 91 s [82/133]; P=0.0004). COL/EPI: test 111 s [92/128] and 127 s [103/146]; P=0.0026). Except for individual outliers, the measured values were in the normal range. CONCLUSIONS In this study, we found no clinically relevant deterioration of platelet function in neurosurgical patients with increased ICP after administration of MAN. Changes that occurred were all within normal ranges.
Collapse
Affiliation(s)
- Kilian Arlt
- Hanover Medical School, Department of Anesthesiology and Intensive Care, Hannover, Germany
| | - Paul Frank
- Hanover Medical School, Department of Anesthesiology and Intensive Care, Hannover, Germany
| | - Markus Flentje
- Hanover Medical School, Department of Anesthesiology and Intensive Care, Hannover, Germany
| | - Hendrik Eismann
- Hanover Medical School, Department of Anesthesiology and Intensive Care, Hannover, Germany
| | - Elvis J Hermann
- Hanover Medical School, Department of Neurosurgery, Hannover, Germany
| | - Joachim K Krauss
- Hanover Medical School, Department of Neurosurgery, Hannover, Germany
| | - Shadi Al-Afif
- Hanover Medical School, Department of Neurosurgery, Hannover, Germany
| | - Thomas Palmaers
- Hanover Medical School, Department of Anesthesiology and Intensive Care, Hannover, Germany -
| |
Collapse
|
3
|
Colclough Z, Estrella MJ, Joyce JM, Hanafy S, Babineau J, Colantonio A, Chan V. Equity considerations in clinical practice guidelines for traumatic brain injury and the criminal justice system: A systematic review. PLoS Med 2024; 21:e1004418. [PMID: 39134041 PMCID: PMC11319042 DOI: 10.1371/journal.pmed.1004418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/22/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is disproportionately prevalent among individuals who intersect or are involved with the criminal justice system (CJS). In the absence of appropriate care, TBI-related impairments, intersecting social determinants of health, and the lack of TBI awareness in CJS settings can lead to lengthened sentences, serious disciplinary charges, and recidivism. However, evidence suggests that most clinical practice guidelines (CPGs) overlook equity and consequently, the needs of disadvantaged groups. As such, this review addressed the research question "To what extent are (1) intersections with the CJS considered in CPGs for TBI, (2) TBI considered in CPGs for CJS, and (3) equity considered in CPGs for CJS?". METHODS AND FINDINGS CPGs were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of identified CPGs on November 2021 and March 2023 (CPGs for TBI) and May 2022 and March 2023 (CPGs for CJS). Only CPGs for TBI or CPGs for CJS were included. We calculated the proportion of CPGs that included TBI- or CJS-specific content, conducted a qualitative content analysis to understand how evidence regarding TBI and the CJS was integrated in the CPGs, and utilised equity assessment tools to understand if and how equity was considered. Fifty-seven CPGs for TBI and 6 CPGs for CJS were included in this review. Fourteen CPGs for TBI included information relevant to the CJS, but only 1 made a concrete recommendation to consider legal implications during vocational evaluation in the forensic context. Two CPGs for CJS acknowledged the prevalence of TBI among individuals in prison and one specifically recommended considering TBI during health assessments. Both CPGs for TBI and CPGs for CJS provided evidence specific to a single facet of the CJS, predominantly in policing and corrections. The use of equity best practices and the involvement of disadvantaged groups in the development process were lacking among CPGs for CJS. We acknowledge limitations of the review, including that our searches were conducted in English language and thus, we may have missed other non-English language CPGs in this review. We further recognise that we are unable to comment on evidence that is not integrated in the CPGs, as we did not systematically search for research on individuals with TBI who intersect with the CJS, outside of CPGs. CONCLUSIONS Findings from this review provide the foundation to consider CJS involvement in CPGs for TBI and to advance equity in CPGs for CJS. Conducting research, including investigating the process of screening for TBI with individuals who intersect with all facets of the CJS, and utilizing equity assessment tools in guideline development are critical steps to enhance equity in healthcare for this disadvantaged group.
Collapse
Affiliation(s)
- Zoe Colclough
- Department of Forensic Science, University of Toronto, Mississauga, Canada
| | - Maria Jennifer Estrella
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Julie Michele Joyce
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Sara Hanafy
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, Canada
- The Institute for Education Research, University Health Network, Toronto, Canada
| | - Angela Colantonio
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Vincy Chan
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
Cáceres E, Divani AA, Rubinos CA, Olivella-Gómez J, Viñan Garcés AE, González A, Alvarado Arias A, Bhatia K, Samadani U, Reyes LF. PaCO 2 Association with Outcomes of Patients with Traumatic Brain Injury at High Altitude: A Prospective Single-Center Cohort Study. Neurocrit Care 2024:10.1007/s12028-024-01982-8. [PMID: 38740704 DOI: 10.1007/s12028-024-01982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/12/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Partial pressure of carbon dioxide (PaCO2) is generally known to influence outcome in patients with traumatic brain injury (TBI) at normal altitudes. Less is known about specific relationships of PaCO2 levels and clinical outcomes at high altitudes. METHODS This is a prospective single-center cohort of consecutive patients with TBI admitted to a trauma center located at 2600 m above sea level. An unfavorable outcome was defined as a Glasgow Outcome Scale-Extended (GOSE) score < 4 at the 6-month follow-up. RESULTS We had a total of 81 patients with complete data, 80% (65/81) were men, and the median (interquartile range) age was 36 (25-50) years. Median Glasgow Coma Scale (GCS) score on admission was 9 (6-14); 49% (40/81) of patients had severe TBI (GCS 3-8), 32% (26/81) had moderate TBI (GCS 12-9), and 18% (15/81) had mild TBI (GCS 13-15). The median (interquartile range) Abbreviated Injury Score of the head (AISh) was 3 (2-4). The frequency of an unfavorable outcome (GOSE < 4) was 30% (25/81), the median GOSE was 4 (2-5), and the median 6-month mortality rate was 24% (20/81). Comparison between patients with favorable and unfavorable outcomes revealed that those with unfavorable outcome were older, (median age 49 [30-72] vs. 29 [22-41] years, P < 0.01), had lower admission GCS scores (6 [4-8] vs. 13 [8-15], P < 0.01), had higher AISh scores (4 [4-4] vs. 3 [2-4], P < 0.01), had higher Acute Physiology and Chronic Health disease Classification System II scores (17 [15-23] vs. 10 [6-14], P < 0.01), had higher Charlson scores (0 [0-2] vs. 0 [0-0], P < 0.01), and had higher PaCO2 levels (mean 35 ± 8 vs. 32 ± 6 mm Hg, P < 0.01). In a multivariate analysis, age (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.1-1.30, P < 0.01), AISh (OR 4.7, 95% CI 1.55-21.0, P < 0.05), and PaCO2 levels (OR 1.23, 95% CI 1.10-1.53, P < 0.05) were significantly associated with the unfavorable outcomes. When applying the same analysis to the subgroup on mechanical ventilation, AISh (OR 5.4, 95% CI 1.61-28.5, P = 0.017) and PaCO2 levels (OR 1.36, 95% CI 1.13-1.78, P = 0.015) remained significantly associated with the unfavorable outcome. CONCLUSIONS Higher PaCO2 levels are associated with an unfavorable outcome in ventilated patients with TBI. These results underscore the importance of PaCO2 levels in patients with TBI and whether it should be adjusted for populations living at higher altitudes.
Collapse
Affiliation(s)
- Eder Cáceres
- Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chía, Colombia.
- Department of Bioscience, School of Engineering, Universidad de La Sabana, Chía, Colombia.
- Department of Critical Care, Clínica Universidad de La Sabana, Chía, Colombia.
| | - Afshin A Divani
- Department of Neurology, The University of New Mexico, Albuquerque, NM, USA
| | - Clio A Rubinos
- Department of Neurology, University of North Carolina, Chapel Hill, NC, USA
| | - Juan Olivella-Gómez
- Department of Critical Care, Clínica Universidad de La Sabana, Chía, Colombia
| | | | - Angélica González
- Department of Critical Care, Clínica Universidad de La Sabana, Chía, Colombia
| | | | - Kunal Bhatia
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Uzma Samadani
- Department of Neurosurgery, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Luis F Reyes
- Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chía, Colombia
- Department of Critical Care, Clínica Universidad de La Sabana, Chía, Colombia
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Syzdykbayev M, Kazymov M, Aubakirov M, Kurmangazina A, Kairkhanov E, Kazangapov R, Bryzhakhina Z, Imangazinova S, Sheinin A. A Modern Approach to the Treatment of Traumatic Brain Injury. MEDICINES (BASEL, SWITZERLAND) 2024; 11:10. [PMID: 38786549 PMCID: PMC11123131 DOI: 10.3390/medicines11050010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/18/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
Background: Traumatic brain injury manifests itself in various forms, ranging from mild impairment of consciousness to severe coma and death. Traumatic brain injury remains one of the leading causes of morbidity and mortality. Currently, there is no therapy to reverse the effects associated with traumatic brain injury. New neuroprotective treatments for severe traumatic brain injury have not achieved significant clinical success. Methods: A literature review was performed to summarize the recent interdisciplinary findings on management of traumatic brain injury from both clinical and experimental perspective. Results: In the present review, we discuss the concepts of traditional and new approaches to treatment of traumatic brain injury. The recent development of different drug delivery approaches to the central nervous system is also discussed. Conclusions: The management of traumatic brain injury could be aimed either at the pathological mechanisms initiating the secondary brain injury or alleviating the symptoms accompanying the injury. In many cases, however, the treatment should be complex and include a variety of medical interventions and combination therapy.
Collapse
Affiliation(s)
- Marat Syzdykbayev
- Department of Hospital Surgery, Anesthesiology and Reanimatology, Semey Medical University, Semey 071400, Kazakhstan
| | - Maksut Kazymov
- Department of General Practitioners, Semey Medical University, Semey 071400, Kazakhstan
| | - Marat Aubakirov
- Department of Pediatric Surgery, Semey Medical University, Semey 071400, Kazakhstan
| | - Aigul Kurmangazina
- Committee for Medical and Pharmaceutical Control of the Ministry of Health of the Republic of Kazakhstan for East Kazakhstan Region, Ust-Kamenogorsk 070004, Kazakhstan
| | - Ernar Kairkhanov
- Pavlodar Branch of Semey Medical University, Pavlodar S03Y3M1, Kazakhstan
| | - Rustem Kazangapov
- Pavlodar Branch of Semey Medical University, Pavlodar S03Y3M1, Kazakhstan
| | - Zhanna Bryzhakhina
- Department Psychiatry and Narcology, Semey Medical University, Semey 071400, Kazakhstan
| | - Saule Imangazinova
- Department of Therapy, Astana Medical University, Astana 010000, Kazakhstan
| | - Anton Sheinin
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv 69978, Israel
| |
Collapse
|
6
|
Yan A, Torpey A, Morrisroe E, Andraous W, Costa A, Bergese S. Clinical Management in Traumatic Brain Injury. Biomedicines 2024; 12:781. [PMID: 38672137 PMCID: PMC11048642 DOI: 10.3390/biomedicines12040781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 04/28/2024] Open
Abstract
Traumatic brain injury is one of the leading causes of morbidity and mortality worldwide and is one of the major public healthcare burdens in the US, with millions of patients suffering from the traumatic brain injury itself (approximately 1.6 million/year) or its repercussions (2-6 million patients with disabilities). The severity of traumatic brain injury can range from mild transient neurological dysfunction or impairment to severe profound disability that leaves patients completely non-functional. Indications for treatment differ based on the injury's severity, but one of the goals of early treatment is to prevent secondary brain injury. Hemodynamic stability, monitoring and treatment of intracranial pressure, maintenance of cerebral perfusion pressure, support of adequate oxygenation and ventilation, administration of hyperosmolar agents and/or sedatives, nutritional support, and seizure prophylaxis are the mainstays of medical treatment for severe traumatic brain injury. Surgical management options include decompressive craniectomy or cerebrospinal fluid drainage via the insertion of an external ventricular drain. Several emerging treatment modalities are being investigated, such as anti-excitotoxic agents, anti-ischemic and cerebral dysregulation agents, S100B protein, erythropoietin, endogenous neuroprotectors, anti-inflammatory agents, and stem cell and neuronal restoration agents, among others.
Collapse
Affiliation(s)
- Amy Yan
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.Y.); (A.T.); (W.A.); (A.C.)
| | - Andrew Torpey
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.Y.); (A.T.); (W.A.); (A.C.)
| | - Erin Morrisroe
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Wesam Andraous
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.Y.); (A.T.); (W.A.); (A.C.)
| | - Ana Costa
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.Y.); (A.T.); (W.A.); (A.C.)
| | - Sergio Bergese
- Department of Anesthesiology and Neurological Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| |
Collapse
|
7
|
Brensing P, Greve S, Hojeij R, Dammann P, Felderhoff-Müser U, Dohna-Schwake C, Bruns N. Current practice of intracranial pressure monitoring in children with severe traumatic brain injury-a nationwide prospective surveillance study in Germany. Front Pediatr 2024; 12:1355771. [PMID: 38405592 PMCID: PMC10884239 DOI: 10.3389/fped.2024.1355771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/31/2024] [Indexed: 02/27/2024] Open
Abstract
Background For management of severe traumatic brain injuries (sTBI) in children, the overall level of evidence to guide diagnostic and therapeutic procedures is low. Since 2016, international guidelines have subsequently suggested invasive intracranial pressure (ICP) monitoring in patients with initial Glasgow Coma Scale (GCS) ≤8. In Germany, ICP monitoring was an individual case decision from 2011 until the 2022 update of the German pediatric TBI guideline. The aim of this study was to evaluate current clinical practice of invasive ICP monitoring in Germany in children <10 years with respect to guideline recommendations. Methods Anonymized clinical data on sTBI cases <10 years of age were collected in a nationwide prospective surveillance study via the German Pediatric Surveillance Unit ESPED from July 2019 until June 2022. Inclusion criteria for the surveillance study were sTBI (initial GCS ≤8) or neurosurgery following TBI. For this analysis, only cases with GCS ≤8 were subject to the present analysis. Descriptive analyses were performed to assess the proportion of ICP monitored patients and describe the cohort. Results Out of 217 reported cases, 102 cases met the inclusion criteria and thus qualified for ICP monitoring. Of these, 37 (36%) received ICP monitoring. Monitored patients were older, had lower median GCS values at presentation (4 vs. 5), higher mortality (32% vs. 22%), and were more frequently diagnosed with cerebral edema (68% vs. 37%). Conclusion In children <10 years with sTBI, the present clinical management regarding ICP monitoring deviates from the current German national and international guidelines. The reasons remain unclear, with the low level of evidence in the field of ICP monitoring and the recency of changes in guideline recommendations as potential contributors. Prospective interventional studies should elucidate the benefit of ICP monitoring and ICP directed therapies to provide evidence-based recommendations on ICP monitoring.
Collapse
Affiliation(s)
- Pia Brensing
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sandra Greve
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rayan Hojeij
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Philipp Dammann
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
8
|
Caceres E, Divani AA, Rubinos CA, Olivella-Gómez J, Viñán-Garcés AE, González A, Alvarado-Arias A, Bathia K, Samadani U, Reyes LF. PaCO2 Association with Traumatic Brain Injury Patients Outcomes at High Altitude: A Prospective Single-Center Cohort Study. RESEARCH SQUARE 2024:rs.3.rs-3876988. [PMID: 38343855 PMCID: PMC10854293 DOI: 10.21203/rs.3.rs-3876988/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Background partial pressure of carbon dioxide (PaCO2) is generally known to influence outcome in patients with traumatic brain injury (TBI) at normal altitudes. Less is known about specific relationships of PaCO2 levels and clinical outcomes at high altitudes. Methods This is a prospective single-center cohort of consecutive TBI patients admitted to a trauma center located at 2600 meter above sea level. An unfavorable outcome was defined as the Glasgow Outcome Scale-Extended (GOSE) < 4 at 6-month follow-up. Results 81 patients with complete data, 80% (65/81) were men, and median (IQR) age was 36 (25-50) years). Median Glasgow Coma Scale (GCS) on admission was 9 (6-14), 49% (40/81) were severe (GCS: 3-8), 32% (26/81) moderate (GCS 12 - 9), and 18% (15/81) mild (GCS 13-15) TBI. The median (IQR) Abbreviated Injury Score of the Head (AISh) was 3 (2-4). Frequency of an unfavorable outcome (GOSE < 4) was 30% (25/81), median GOSE was 4 (2-5), and 6-month mortality was 24% (20/81). Comparison between patients with favorable and unfavorable outcomes revealed that those with unfavorable outcome were older, median [49 (30-72) vs. 29 (22-41), P < 0.01], had lower admission GCS [6 (4-8) vs. 13 (8-15), P < 0.01], higher AIS head [4 (4-4) vs. 3(2-4), p < 0.01], higher APACHE II score [17(15-23) vs 10 (6-14), < 0.01), higher Charlson score [0(0-2) vs. 0 (0-0), P < 0.01] and higher PaCO2 (mmHg), mean ± SD, 39 ± 9 vs. 32 ± 6, P < 0.01. In a multivariate analysis, age (OR 1.14 95% CI 1.1-1.30, P < 0.01), AISh (OR 4.7 95% CI 1.55-21.0, P < 0.05), and PaCO2 (OR 1.23 95% CI: 1.10-1.53, P < 0.05) were significantly associated with the unfavorable outcomes. When applying the same analysis to the subgroup on mechanical ventilation, AISh (OR 5.4 95% CI: 1.61-28.5, P = 0.017) and PaCO2 (OR 1.36 95% CI: 1.13-1.78, P = 0.015) remained significantly associated with the unfavorable outcome. Conclusion Higher PaCO2 levels are associated with an unfavorable outcome in ventilated TBI patients. These results underscore the importance of PaCO2 level in TBI patients and whether it should be adjusted for populations living at higher altitudes.
Collapse
Affiliation(s)
| | - Afshin A Divani
- University of New Mexico - Albuquerque: The University of New Mexico
| | - Clio A Rubinos
- University of North Carolina at Chapel Hill Health Sciences Library: The University of North Carolina at Chapel Hill
| | | | | | | | - Alexis Alvarado-Arias
- University of Mississippi University Hospital: The University of Mississippi Medical Center
| | - Kunal Bathia
- University of Mississippi University Hospital: The University of Mississippi Medical Center
| | | | | |
Collapse
|
9
|
Ito H, Nakamura Y, Togami Y, Onishi S, Nakao S, Ogura H, Oda J. Relationship between extravascular leakage and clinical outcome on computed tomography of isolated traumatic brain injury. Acute Med Surg 2024; 11:e931. [PMID: 38385145 PMCID: PMC10879720 DOI: 10.1002/ams2.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/27/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
Aim This study investigated whether contrast extravasation on computed tomography (CT) angiography in patients with traumatic brain injury (TBI) is associated with death or surgical procedures. Methods Patients over 18 years old, directly brought in by ambulance with an isolated head injury and confirmed to have acute intracranial hemorrhage on a CT scan upon admission between 2010 and 2020, were included. The primary outcome was mortality, and the secondary outcome was neurosurgical procedures performed from admission to discharge from the intensive care unit. Multivariable logistic regression analyses were performed to evaluate the association between these outcomes and contrast extravasation. Results The analysis included 188 patients with a median age of 65 years, 123 men (65.4%), 34 deaths (18.1%), and 91 surgeries (48.4%). Among the 66 patients with contrast extravasation, 22 (33.3%) died and 47 (71.2%) required surgery. Among the 122 patients with no contrast extravasation, 12 (9.8%) died, and 44 (36.1%) required surgery. The presence or absence of extravascular leakage was associated with death (odds ratio, 3.6 [95% CI: 1.2-12.2]) and surgery (odds ratio, 7.6 [95% CI: 2.5-22.7]). Conclusion Contrast extravasation was associated with mortality and performance of surgery in patients with an isolated head injury.
Collapse
Affiliation(s)
- Hiroshi Ito
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Youhei Nakamura
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Yuki Togami
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Shinya Onishi
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaOsakaJapan
| |
Collapse
|
10
|
Cui Z. Application of quality control circle to the surgery of craniocerebral trauma. Asian J Surg 2023; 46:6071-6072. [PMID: 37770358 DOI: 10.1016/j.asjsur.2023.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
- Zhiye Cui
- Department of Neurosurgery, Shanghai Pudong New District Zhoupu Hospital (Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital), No. 1500 Zhouyuan Road, Pudong New District, Shanghai, 201318, PR China.
| |
Collapse
|
11
|
Moyer JD, Léger M, Trolonge B, Codorniu A, Lhermitte A, Gaberel T, Jeantrelle C, Gakuba C. Impact of early external ventricular drainage on functional outcome after traumatic brain injury: a bicentric retrospective cohort analysis. Neurochirurgie 2023; 69:101487. [PMID: 37696447 DOI: 10.1016/j.neuchi.2023.101487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Several studies have confirmed that external ventricular drain decreases intracranial pressure (ICP) after traumatic brain injury (TBI). Considering its impact on ICP control and cerebral waste metabolites clearance, timing of external ventricular drain (EVD) insertion could improve CSF drainage efficiency. The aim of the study was to evaluate the impact of early EVD versus a later one on the 3-month outcome. METHODS For this retrospective cohort study conducted in two regional trauma-center (Caen CHU Côte de Nacre and Beaujon Hospital) between May 2011 and March 2019, all patients with intracranial hypertension following TBI and treated with EVD were included. We defined the early EVD by drainage within the 24 h of the hospital admission and the late EVD insertion by drainage beyond 24 h. A poor outcome was defined as a Glasgow Outcome Scale of one or two at 3 months. RESULTS Among the cohort of 671 patients, we analyzed 127 patients. Sixty-one (48.0%) patients had an early insertion of EVD. In the early EVD group, the mean time to insertion was 10 h versus 55 h in the late EVD group. Among the analyzed patients, 69 (54.3%) had a poor outcome including 39 (63.9%) in the early group and 30 (45.5%) in the later one. After adjustment on prognostic factors, early EVD insertion was not associated with a decrease in a poor outcome at 3-months (OR = 1.80 [0.73-4.53]). CONCLUSION Early insertion of EVD (<24 h) for intracranial hypertension after TBI was not associated with improved outcome at 3 months.
Collapse
Affiliation(s)
- Jean-Denis Moyer
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, Paris, France.
| | - Maxime Léger
- Department of Anesthesiology and Critical Care, CHU de Angers, Angers, France
| | - Baptiste Trolonge
- Department of Anesthesiology and Critical Care, CHU de Caen Normandie, 14000 Caen, France
| | - Anaïs Codorniu
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, Paris, France
| | - Amaury Lhermitte
- Department of Anesthesiology and Critical Care, CHU de Caen Normandie, 14000 Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, CHU de Caen Normandie, 14000 Caen, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain at Caen-Normandie, Cyceron, 14000 Caen, France
| | - Caroline Jeantrelle
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, Paris, France
| | - Clément Gakuba
- Department of Anesthesiology and Critical Care, CHU de Caen Normandie, 14000 Caen, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain at Caen-Normandie, Cyceron, 14000 Caen, France
| |
Collapse
|
12
|
Esnault P, Houcinat N, de Malleray H, Quere PL, Cardinale M, D'aranda E, Joubert C, Dagain A, Goutorbe P, Meaudre E. ABO blood type and functional neurological outcome in patients with severe traumatic brain injury. J Trauma Acute Care Surg 2023; 95:737-745. [PMID: 37335132 DOI: 10.1097/ta.0000000000004041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND The ABO blood system has been involved in the pathogenesis of several diseases, including coagulopathy and bleeding complications. In trauma patients, blood type A has been associated with acute respiratory distress syndrome, and recently, blood type O has been associated with all-cause mortality. The purpose of this study was to assess the association between ABO blood types and long-term functional outcomes in critically ill patients with severe traumatic brain injury (TBI). METHODS We conducted a single-center, retrospective, observational study including all patients admitted to the intensive care unit with severe TBI (defined as a Glasgow Coma Scale score of ≤8) between January 2007 and December 2018. Patient characteristics and outcomes were extracted from a prospective registry of all intubated patients admitted to the intensive care unit for TBI. ABO blood types were retrospectively retrieved from patient medical records. The association between ABO blood type (A, B, AB, and O) and unfavorable functional outcome (defined by a Glasgow Outcome Scale score between 1 and 3) 6 months after injury was assessed in univariate and multivariate analysis. RESULTS A total of 333 patients meeting the inclusion criteria were included. There were 151 type O (46%), 131 type A (39%), 37 type B (11%), and 12 type AB patients (4%). No significant differences in baseline demographic, clinical, or biological characteristics were observed between blood types. The prevalence of unfavorable outcome was significantly different between the four groups. After adjustment for confounders, blood type O was significantly associated with unfavorable outcome at 6 months (odds ratio, 1.97; confidence interval [1.03-3.80]; p = 0.042). The prevalence of coagulopathy or progressive hemorrhagic injury was not statistically different between blood types ( p = 0.575 and p = 0.813, respectively). CONCLUSION Blood type O appears to be associated with unfavorable long-term functional outcome in critically ill patients with severe TBI. Further studies are needed to detail the mechanism underlying this relationship. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
Collapse
Affiliation(s)
- Pierre Esnault
- From the Intensive Care Unit (P.E., N.H., H.d.M., P.-L.Q., M.C., E.D., P.G., E.M.), and Department of Neurosurgery (C.J., A.D.), Sainte Anne Military Hospital, Toulon; and French Military Health Service Academy Unit (A.D., E.M.), Ecole du Val-de-Grâce, Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Manet R, Joubert C, Balanca B, Taverna XJ, Monneuse O, David JS, Dagain A. Neuro damage control: current concept and civilian applications. Neurochirurgie 2023; 69:101505. [PMID: 37806039 DOI: 10.1016/j.neuchi.2023.101505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/26/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
Damage control (DC) initially referred to abbreviated (<1 h) surgical procedures to control abdominal hemorrhage in severe trauma patients, to avoid the 'bloody vicious circle' of hypothermia-coagulopathy-acidosis-hypocalcemia. Progressively, the concept was extended to pre-hospital and peri-operative surgical and non-surgical trauma care. The DC strategy can be applied either in a single severe trauma patient at risk of progression toward the bloody vicious circle or in case of limited or overwhelmed health resources (deprived environment, mass casualties, etc.). DC strategies in neurological casualties have improved over the last decade in military neurosurgeons, but remain poorly codified in civilian settings. In this comprehensive review, we summarize the current concept of neuro-DC, which includes surgical and medical care for neurological injuries as part of a DC strategy. Neuro-DC basically consists in: (i) preventing secondary brain injury; (ii) controlling intracranial bleeding; (iii) controlling intracranial pressure; (iv) limiting contamination of compound wounds; and (v) achieving secondary anatomical restoration.
Collapse
Affiliation(s)
- Romain Manet
- Service de Neurochirurgie B, Hôpital Neurologique Wertheimer, Hospices Civils de Lyon, Lyon, France.
| | - Christophe Joubert
- Service de Neurochirurgie, Hôpital d'Instruction des Armées St Anne, Toulon, France
| | - Baptiste Balanca
- Service de Neuro-Réanimation, Hôpital Neurologique Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Xavier-Jean Taverna
- Service de Réanimation Chirurgicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Monneuse
- Service de Chirurgie d'Urgence, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Stéphane David
- Service de Réanimation, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Dagain
- Service de Neurochirurgie, Hôpital d'Instruction des Armées St Anne, Toulon, France
| |
Collapse
|
14
|
Payen JF, Launey Y, Chabanne R, Gay S, Francony G, Gergele L, Vega E, Montcriol A, Couret D, Cottenceau V, Pili-Floury S, Gakuba C, Hammad E, Audibert G, Pottecher J, Dahyot-Fizelier C, Abdennour L, Gauss T, Richard M, Vilotitch A, Bosson JL, Bouzat P. Intracranial pressure monitoring with and without brain tissue oxygen pressure monitoring for severe traumatic brain injury in France (OXY-TC): an open-label, randomised controlled superiority trial. Lancet Neurol 2023; 22:1005-1014. [PMID: 37863590 DOI: 10.1016/s1474-4422(23)00290-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Optimisation of brain oxygenation might improve neurological outcome after traumatic brain injury. The OXY-TC trial explored the superiority of a strategy combining intracranial pressure and brain tissue oxygen pressure (PbtO2) monitoring over a strategy of intracranial pressure monitoring only to reduce the proportion of patients with poor neurological outcome at 6 months. METHODS We did an open-label, randomised controlled superiority trial at 25 French tertiary referral centres. Within 16 h of brain injury, patients with severe traumatic brain injury (aged 18-75 years) were randomly assigned via a website to be managed during the first 5 days of admission to the intensive care unit either by intracranial pressure monitoring only or by both intracranial pressure and PbtO2 monitoring. Randomisation was stratified by age and centre. The study was open label due to the visibility of the intervention, but the statisticians and outcome assessors were masked to group allocation. The therapeutic objectives were to maintain intracranial pressure of 20 mm Hg or lower, and to keep PbtO2 (for those in the dual-monitoring group) above 20 mm Hg, at all times. The primary outcome was the proportion of patients with an extended Glasgow Outcome Scale (GOSE) score of 1-4 (death to upper severe disability) at 6 months after injury. The primary analysis was reported in the modified intention-to-treat population, which comprised all randomly assigned patients except those who withdrew consent or had protocol violations. This trial is registered with ClinicalTrials.gov, NCT02754063, and is completed. FINDINGS Between June 15, 2016, and April 17, 2021, 318 patients were randomly assigned to receive either intracranial pressure monitoring only (n=160) or both intracranial pressure and PbtO2 monitoring (n=158). 27 individuals with protocol violations were not included in the modified intention-to-treat analysis. Thus, the primary outcome was analysed for 144 patients in the intracranial pressure only group and 147 patients in the intracranial pressure and PbtO2 group. Compared with intracranial pressure monitoring only, intracranial pressure and PbtO2 monitoring did not reduce the proportion of patients with GOSE score 1-4 (51% [95% CI 43-60] in the intracranial pressure monitoring only group vs 52% [43-60] in the intracranial pressure and PbtO2 monitoring group; odds ratio 1·0 [95% CI 0·6-1·7]; p=0·95). Two (1%) of 144 participants in the intracranial pressure only group and 12 (8%) of 147 participants in the intracranial pressure and PbtO2 group had catheter dysfunction (p=0.011). Six patients (4%) in the intracranial pressure and PbtO2 group had an intracrebral haematoma related to the catheter, compared with none in the intracranial pressure only group (p=0.030). No significant difference in deaths was found between the two groups at 12 months after injury. At 12 months, 33 deaths had occurred in the intracranial pressure group: 25 (76%) were attributable to the brain trauma, six (18%) were end-of-life decisions, and two (6%) due to sepsis. 34 deaths had occured in the intracranial pressure and PbtO2 group at 12 months: 25 (74%) were attributable to the brain trauma, six (18%) were end-of-life decisions, one (3%) due to pulmonary embolism, one (3%) due to haemorrhagic shock, and one (3%) due to cardiac arrest. INTERPRETATION After severe non-penetrating traumatic brain injury, intracranial pressure and PbtO2 monitoring did not reduce the proportion of patients with poor neurological outcome at 6 months. Technical failures related to intracerebral catheter and intracerebral haematoma were more frequent in the intracranial pressure and PbtO2 group. Further research is needed to assess whether a targeted approach to multimodal brain monitoring could be useful in subgroups of patients with severe traumatic brain injury-eg, those with high intracranial pressure on admission. FUNDING The French National Program for Clinical Research, La Fondation des Gueules Cassées, and Integra Lifesciences.
Collapse
Affiliation(s)
- Jean-François Payen
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Grenoble, Universitaire Grenoble Alpes, Grenoble, France; INSERM U1216, Grenoble Institut Neurosciences, Grenoble, France.
| | - Yoann Launey
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Russell Chabanne
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Samuel Gay
- Department of Intensive Care, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Gilles Francony
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Grenoble, Universitaire Grenoble Alpes, Grenoble, France; INSERM U1216, Grenoble Institut Neurosciences, Grenoble, France
| | - Laurent Gergele
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Saint-Etienne, Saint-Etienne, France
| | - Emmanuel Vega
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Lille, Lille, France
| | - Ambroise Montcriol
- Department of Intensive Care, Hopital Instruction des Armées Saint-Anne, Toulon, France
| | - David Couret
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Sud, Reunion, France
| | - Vincent Cottenceau
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Sebastien Pili-Floury
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Clement Gakuba
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - Emmanuelle Hammad
- Department of Anaesthesia and Intensive Care, Hôpital Nord, Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Gerard Audibert
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Nancy, Nancy, France
| | - Julien Pottecher
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Strasbourg, Strasbourg, France
| | - Claire Dahyot-Fizelier
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Lamine Abdennour
- Department of Anaesthesia and Intensive Care, Hôpital Pitie-Salpetriere, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Tobias Gauss
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Grenoble, Universitaire Grenoble Alpes, Grenoble, France; INSERM U1216, Grenoble Institut Neurosciences, Grenoble, France
| | - Marion Richard
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Grenoble, Universitaire Grenoble Alpes, Grenoble, France; INSERM U1216, Grenoble Institut Neurosciences, Grenoble, France
| | - Antoine Vilotitch
- Department of Public Health, Centre Hospitalier Universitaire Grenoble, Universitaire Grenoble Alpes, Grenoble, France
| | - Jean-Luc Bosson
- Department of Public Health, Centre Hospitalier Universitaire Grenoble, Universitaire Grenoble Alpes, Grenoble, France
| | - Pierre Bouzat
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Grenoble, Universitaire Grenoble Alpes, Grenoble, France; INSERM U1216, Grenoble Institut Neurosciences, Grenoble, France
| |
Collapse
|
15
|
Rowe M, Brown J, Marsh A, Thompson J. Predicting Mortality Following Traumatic Brain Injury or Subarachnoid Hemorrhage: An Analysis of the Validity of Standardized Mortality Ratios Obtained From the APACHE II and ICNARC H-2018 Models. J Neurosurg Anesthesiol 2023; 35:292-298. [PMID: 35125410 DOI: 10.1097/ana.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Standardized mortality ratios (SMRs), calculated using the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) and Intensive Care National Audit and Research Centre H-2018 (ICNARC H-2018 ) risk prediction models, are widely used in UK intensive care units (ICUs) to measure and compare the quality of critical care delivery. Both models incorporate an assumption of Glasgow Coma Score (GCS) if an actual GCS without sedation is not recordable in the first 24 hours after ICU admission. This study assesses the validity of the APACHE II and ICNARC H-2018 models to predict mortality in ICU patients with traumatic brain injury (TBI) or aneurysmal subarachnoid hemorrhage (aSAH) in whom GCS is related to outcomes. METHODS In a retrospective analysis, the SMR calculated by the APACHE II and ICNARC H-2018 models for all UK ICU admissions in a 1-year period was compared with calculated SMRs in TBI/aSAH patients and at 3 GCS groups. Data for patients admitted to a single tertiary neurocritical care unit were similarly analyzed. RESULTS Both models predicted mortality well for the overall TBI/aSAH population; SMR (95% confidence interval) was 1.00 (0.96-1.04) and 0.99 (0.95-1.03) for the APACHE II and ICNARC H-2018 models, respectively. When analyzed by GCS grouping, both models underpredicted mortality in TBI/aSAH patients with GCS ≤8 (SMR, 1.1 [1.05-1.15]) and "unrecordable" GCS (SMR, 1.88 [1.77-1.99]). Similar findings were identified in the local data analysis. DISCUSSION The APACHE II and ICNARC H-2018 models predicted mortality well for the overall TBI/aSAH ICU population but underpredicted mortality when GCS was ≤8 or "unrecordable." This raises questions about the accuracy of these risk prediction models in TBI/aSAH patients and their use to evaluate treatments and compare outcomes between centers.
Collapse
Affiliation(s)
- Matt Rowe
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | | | | |
Collapse
|
16
|
James A, Harrois A, Abback PS, Moyer JD, Jeantrelle C, Hanouz JL, Boutonnet M, Geeraerts T, Godier A, Pottecher J, Garrigue-Huet D, Cotte J, Pasqueron J, Foucrier A, Gauss T, Raux M. Comparison of Injuries Associated With Electric Scooters, Motorbikes, and Bicycles in France, 2019-2022. JAMA Netw Open 2023; 6:e2320960. [PMID: 37389873 PMCID: PMC10314314 DOI: 10.1001/jamanetworkopen.2023.20960] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/11/2023] [Indexed: 07/01/2023] Open
Abstract
Importance Electric scooter (e-scooter) use is increasing in France and in many urban environments worldwide. Yet little is known about injuries associated with use of e-scooters. Objective To describe characteristics and outcomes of major trauma involving e-scooters. Design, Setting, and Participants A multicenter cohort study was conducted in France using the national major trauma registry between January 1, 2019, and December 20, 2022. All patients admitted to a participating major trauma center following a road traffic crash (RTC) involving an e-scooter, a bicycle, or a motorbike were included. Exposure Included patients were compared according to the 3 mechanisms. Main Outcomes and Measures The primary outcome was trauma severity as defined by the Injury Severity Score (ISS). Secondary outcomes included the trends of the number of patients per year, a comparison of the RTC epidemiologic factors, injury severity, resources used, and in-hospital outcomes. Results A total of 5233 patients involved in RTCs were admitted (median age, 33 [IQR, 24-48] years; 4629 [88.5%] men; median ISS, 13 [IQR, 8-22]). The population included 229 e-scooter RTCs (4.4%), 4094 motorbike RTCs (78.2%), and 910 bicycle RTCs (17.4%). The number of patients treated following e-scooter RTCs increased by 2.8-fold in 4 years (from 31 in 2019 to 88 in 2022), while bicycle RTCs increased by 1.2-fold and motorbike RTCs decreased by 0.9-fold. At admission, 36.7% of e-scooter users had a blood alcohol content higher than the legal threshold (n = 84) and 22.5% wore a protective helmet (n = 32). Among e-scooter RTCs, 102 patients (45.5%) had an ISS of 16 or higher. This proportion was similar for patients with motorbike RTCs (1557 [39.7%]; P = .10) and bicycle RTCs (411 [47.3%]; P = .69). With a proportion of 25.9% (n = 50), patients with e-scooter RTCs had twice as many severe traumatic brain injuries (Glasgow Coma Scale ≤8) as motorbike RTCs (445 [11.8%]) and a proportion comparable to bicycle RTCs (174 [22.1%]). The mortality of e-scooter RTCs was 9.2% (n = 20), compared with 5.2% (n = 196) (P = .02) for motorbikes and 10.0% (n = 84) (P = .82) for bicycles. Conclusions and Relevance The findings of this study suggest that trauma involving e-scooters in France has significantly increased over the past 4 years. These patients presented with injury profiles as severe as those of individuals who experienced bicycle or motorbike RTCs, with a higher proportion of severe traumatic brain injury.
Collapse
Affiliation(s)
- Arthur James
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Anatole Harrois
- Department of Anesthesiology and Critical Care, Bicêtre Hospital, AP-HP, University Paris Saclay, Le Kremlin Bicêtre, France
| | - Paer-Selim Abback
- Department of Anesthesiology and Critical Care Medicine, CHU Tours, Tours University Hospital, Tours, France
| | - Jean Denis Moyer
- Department of Anesthesiology and Critical Care Medicine, CHU Caen, Caen University Hospital, Caen, France
| | - Caroline Jeantrelle
- Department of Anaesthesiology and Critical Care Medicine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, Hospital Beaujon, Clichy, France
| | - Jean-Luc Hanouz
- Department of Anesthesiology and Critical Care Medicine, CHU Caen, Caen University Hospital, Caen, France
- Caen Normandy University, Unicaen, Caen, France
| | - Mathieu Boutonnet
- Intensive Care Unit, Military Teaching Hospital Percy, Clamart, France
- Military Medical Academy, Val-de-Grâce, Paris, France
| | - Thomas Geeraerts
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, University Toulouse 3 – Paul Sabatier, Toulouse, France
| | - Anne Godier
- Department of Anesthesia and Critical Care, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France
| | - Julien Pottecher
- Hôpital de Hautepierre, Service d’Anesthésie, Réanimation & Médecine Péri-Opératoire - Université de Strasbourg, Faculté de Médecine, FMTS, EA3072, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Jean Cotte
- Intensive Care Unit, Military Teaching Hospital Sainte-Anne, Toulon, France
| | - Jean Pasqueron
- Department of Anesthesiology and Critical Care, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, France
| | - Arnaud Foucrier
- Department of Anaesthesiology and Critical Care Medicine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, Hospital Beaujon, Clichy, France
- Île-de-France Regional Health Agency, Paris, France
| | - Tobias Gauss
- Anaesthesia Critical Care, Grenoble Alpes University Hospital, 38700 Grenoble, France
| | - Mathieu Raux
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d’Anesthésie Réanimation, F-75013 Paris, France
| |
Collapse
|
17
|
Moyer JD, Elouahmani S, Codorniu A, Abback PS, Jeantrelle C, Goutagny S, Gauss T, Sigaut S. External ventricular drainage for intracranial hypertension after traumatic brain injury: is it really useful? Eur J Trauma Emerg Surg 2023; 49:1227-1234. [PMID: 35169869 DOI: 10.1007/s00068-022-01903-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 01/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSES External ventricular drainage (EVD) is frequently used to control raised intracranial pressure after traumatic brain injury. However, the available evidence about its effectiveness in this context is limited. The aim of this study is to evaluate the effectiveness of EVD to control intracranial pressure and to identify the clinical and radiological factors associated with its success. METHODS For this retrospective cohort study conducted in a Level 1 traumacenter in Paris area between May 2011 and March 2019, all patients with intracranial hypertension and treated with EVD were included. EVD success was defined as an efficient and continuous control of intracranial hypertension avoiding the use of third tier therapies (therapeutic hypothermia, decompressive craniectomy, and barbiturate coma) or avoiding a decision to withdraw life sustaining treatment due to both refractory intracranial hypertension and severity of brain injury lesions. RESULTS 83 patients with EVD were included. EVD was successful in 33 patients (40%). Thirty-two patients (39%) required a decompressive craniectomy, eight patients (9%) received barbiturate coma. In ten cases (12%) refractory intracranial hypertension prompted a protocolized withdrawal of care. Complications occurred in nine patients (11%) (three cases of ventriculitis, six cases of catheter occlusion). Multivariate analysis identified no independent factors associated with EVD success. CONCLUSION In a protocol-based management for traumatic brain injury, EVD allowed intracranial pressure control and avoided third tier therapeutic measures in 40% of cases with a favorable risk-benefit ratio.
Collapse
Affiliation(s)
- Jean-Denis Moyer
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, 100 boulevard du Général Leclerc, 92110, Clichy, France.
| | - Saida Elouahmani
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - Anais Codorniu
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - Paer-Selim Abback
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - Caroline Jeantrelle
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - Stéphane Goutagny
- Department of Neurosurgery, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy, France
- Université de Paris, UFR de Médecine Paris Nord, Paris, France
| | - Tobias Gauss
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - Stéphanie Sigaut
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, 100 boulevard du Général Leclerc, 92110, Clichy, France
- Université de Paris, UFR de Médecine Paris Nord, Paris, France
- NeuroDiderot, Inserm U1141, Université de Paris, Paris, France
| |
Collapse
|
18
|
Wang KW, Zhan CP, Liu YQ, Fu ZZ, Qiu TW, Yu GF. A prospective observational study on utility of serum mesencephalic astrocyte-derived neurotrophic factor as a promising prognostic biomarker of severe traumatic brain injury in humans. Clin Chim Acta 2023; 545:117370. [PMID: 37137461 DOI: 10.1016/j.cca.2023.117370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Mesencephalic astrocyte-derived neurotrophic factor (MANF) is released under endoplasmic reticulum stress, thereby exerting neuroprotective effects. We determined whether serum MANF may be a prognostic biomarker of human severe traumatic brain injury (sTBI). METHODS Serum MANF concentrations of 137 sTBI patients and 137 controls were quantified in this prospective cohort study. Patients with extended Glasgow outcome scale (GOSE) scores of 1-4 at post-traumatic 6 months were considered to have poor prognosis. Relationships between serum MANF concentrations and severity plus prognosis were investigated using multivariate analyses. Area under receiver operating characteristic curve (AUC) was calculated for reflecting prognostic efficiency. RESULTS As compared to controls, there was a significant increase of serum MANF concentrations after sTBI (median, 18.5 ng/ml versus 3.0 ng/ml; P<0.001), which was independently correlated with Glasgow coma scale (GCS) scores [β, -3.000; 95% confidence interval (CI), -4.525--1.476; VIF, 2.216; P=0.001], Rotterdam computed tomography (CT) scores (β, 4.020; 95% CI, 1.446-6.593; VIF, 2.234; P=0.002) and GOSE scores (β, -0.056; 95% CI, -0.089--0.023; VIF, 1.743; P=0.011). Serum MANF concentrations substantially distinguished risk of poor prognosis with AUC of 0.795 (95% CI, 0.718-0.859) and its concentrations >23.9 ng/ml was predictive of poor prognosis with 67.7% sensitivity and 81.9% specificity. Serum MANF concentrations combined with GCS scores and Rotterdam CT scores displayed markedly higher prognostic predictive ability than each of them (all P<0.05). Using restricted cubic spline, there was a linear correlation between serum MANF concentrations and poor prognosis (P=0.256). Serum MANF concentrations > 23.9 ng/ml was independently associated with poor prognosis (odds ratio, 2.911; 95% CI, 1.057-8.020; P=0.039). A nomogram was built, where serum MANF concentrations > 23.9 ng/ml, GCS scores and Rotterdam CT scores were integrated. Hosmer and Lemeshow test, calibration curve and decision curve analysis demonstrated such a prediction model was comparatively stable and was of relatively high clinical benefit. CONCLUSIONS Substantially increased serum MANF concentrations after sTBI are highly correlated with traumatic severity and are independently predictive of long-term poor prognosis, suggesting that serum MANF may represent a useful prognostic biochemical marker of human sTBI.
Collapse
Affiliation(s)
- Ke-Wei Wang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Cheng-Peng Zhan
- Department of Neurosurgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, People's Republic of China
| | - Yong-Qi Liu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Zhi-Zhan Fu
- Department of Neurosurgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, People's Republic of China
| | - Tian-Wen Qiu
- Department of Neurosurgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, People's Republic of China
| | - Guo-Feng Yu
- Department of Neurosurgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, People's Republic of China.
| |
Collapse
|
19
|
Esteban-Zubero E, García-Muro C, Alatorre-Jiménez MA. Fluid therapy and traumatic brain injury: A narrative review. Med Clin (Barc) 2023:S0025-7753(23)00107-0. [PMID: 37031064 DOI: 10.1016/j.medcli.2023.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 04/10/2023]
Abstract
Traumatic brain injury (TBI) is an important health and social problem. The mechanism of damage of this entity could be divided into two phases: (1) a primary acute injury because of the traumatic event; and (2) a secondary injury due to the hypotension and hypoxia generated by the previous lesion, which leads to ischemia and necrosis of neural cells. Cerebral edema is one of the most important prognosis markers observed in TBI. In the early stages of TBI, the cerebrospinal fluid compensates the cerebral edema. However, if edema increases, this mechanism fails, increasing intracranial pressure. To avoid this chain effect, several treatments are applied in the clinical practice, including elevation of the head of the bed, maintenance of normothermia, pain and sedation drugs, mechanical ventilation, neuromuscular blockade, controlled hyperventilation, and fluid therapy (FT). The goal of FT is to improve the circulatory system to avoid the lack of oxygen to organs. Therefore, rapid and early infusion of large volumes of crystalloids is performed in clinical practice to restore blood volume and blood pressure. Despite the relevance of FT in the early management of TBI, there are few clinical trials regarding which solution is better to apply. The aim of this study is to provide a narrative review about the role of the different types of FT used in the daily clinical practice on the management of TBI. To achieve this objective, a physiopathological approach to this entity will be also performed, summarizing why the different types of FT are used.
Collapse
|
20
|
Chtara K, Bradai S, Baccouche N, Toumi N, Amar WB, Chelly H, Bahloul M, Bouaziz M. Post-traumatic cerebral venous sinus thrombosis in an intensive care unit: A case series of ten patients. JOURNAL DE MEDECINE VASCULAIRE 2023; 48:62-68. [PMID: 37422329 DOI: 10.1016/j.jdmv.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/23/2023] [Indexed: 07/10/2023]
Abstract
Post-traumatic cerebral venous sinus thrombosis is one of the several causes of cerebral venous thrombosis, but its early diagnosis and management are still difficult in this traumatic context. Our objective is to describe clinical and radiological presentations and to report specific management and outcomes of this rare post-traumatic complication. We reported in this manuscript a case series of 10 patients hospitalized in the intensive care department with post-traumatic cerebral venous thrombosis. Demographic, clinical, and radiological data and their medical management are reported. The incidence of post-traumatic cerebral venous sinus thrombosis in our institution was 4.2%. Cerebral thrombophlebitis was diagnosed incidentally on the initial body scan, on ICU admission in five patients. The left or right lateral sinus was affected in four patients; the sigmoid sinus was affected in 6 patients. Five patients had a thrombosis in the jugular vein. Seven patients had 2 or 3 sites of occlusion. All patients had medical treatment. No hemorrhagic complications were reported. The total duration of anticoagulation was available in 5 cases. A follow-up of MRI or CT scan at 3 months revealed complete sinus recanalization in three patients. Post-traumatic cerebral venous sinus thrombosis in the intensive care department remains underdiagnosed because of the common clinical presentation of traumatic brain injury. Its incidence is increasing because of the increase in high-velocity accidents. And, it seems necessary to conduct prospective studies with a large cohort of patients in the intensive care department.
Collapse
Affiliation(s)
- Kamilia Chtara
- Department of Intensive Care, Habib-Bourguiba University Hospital, University of Sfax, 3029 Sfax, Tunisia.
| | - Sabrine Bradai
- Department of Intensive Care, Habib-Bourguiba University Hospital, University of Sfax, 3029 Sfax, Tunisia
| | - Najeh Baccouche
- Department of Intensive Care, Habib-Bourguiba University Hospital, University of Sfax, 3029 Sfax, Tunisia
| | - Nozha Toumi
- Department of Radiology, Habib-Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Wiem Ben Amar
- Department of Forensic Medicine, Habib-Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Hedi Chelly
- Department of Intensive Care, Habib-Bourguiba University Hospital, University of Sfax, 3029 Sfax, Tunisia
| | - Mabrouk Bahloul
- Department of Intensive Care, Habib-Bourguiba University Hospital, University of Sfax, 3029 Sfax, Tunisia
| | - Mounir Bouaziz
- Department of Intensive Care, Habib-Bourguiba University Hospital, University of Sfax, 3029 Sfax, Tunisia
| |
Collapse
|
21
|
Maegele M, Gauss T, Cesareo E, Osten P, Ahnert T. [Intrahospital trauma flowcharts : Cognitive support for optimization and acceleration of resuscitation room management of patients with severe injuries and polytrauma]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00113-023-01305-0. [PMID: 36943517 DOI: 10.1007/s00113-023-01305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/23/2023]
Abstract
Morbidity and mortality after severe injury remain high despite substantial improvements in management and care over the past two decades, especially in the early phase of treatment. This is mainly due to still existing and insufficient adherence to evidence-based guidelines. The latter are considered the backbone of optimum treatment of the severely injured; however, the complexity and format often still preclude their clinical acceptance and immediate use in the resuscitation room. As a result of a close colaboration between two French medical societies a series of user-friendly flowcharts were developed as cognitive aids to support early acute diagnosis and treatment for the resuscitation room management of severely injured patients. These have been translated and adapted to the current "S3 Guideline on the Clinical Management of Severe Injuries and Polytrauma" coordinated by the Association of Scientific Medical Societies in Germany (AWMF).
Collapse
Affiliation(s)
- Marc Maegele
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln-Merheim, Universität Witten/Herdecke (UW/H), Ostmerheimerstr. 200, 51109, Köln, Deutschland.
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke (UW/H), Campus Köln-Merheim, Köln, Deutschland.
| | - Tobias Gauss
- Pole Anesthésie Réanimation, Déchocage Bloc des Urgences, Université Grenoble Alpes, Grenoble, Frankreich
| | - Eric Cesareo
- Pole URMARS (Urgences-Réanimation Médicale - Anesthésie-Réanimation-SAMU), Groupement Hospitalier Centre, Hopital Edouart Herriot, Lyon, Frankreich
| | - Philipp Osten
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln-Merheim, Universität Witten/Herdecke (UW/H), Ostmerheimerstr. 200, 51109, Köln, Deutschland
| | - Tobias Ahnert
- Rettungsdienst Kreis Euskirchen, Zentrale Notaufnahme, Kreiskrankenhaus Mechernich, Mechernich, Deutschland
| |
Collapse
|
22
|
Kuupiel D, Jessani NS, Boffa J, Naude C, De Buck E, Vandekerckhove P, McCaul M. Prehospital clinical practice guidelines for unintentional injuries: a scoping review and prioritisation process. BMC Emerg Med 2023; 23:27. [PMID: 36915034 PMCID: PMC10010958 DOI: 10.1186/s12873-023-00794-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Globally, millions of people die and many more develop disabilities resulting from injuries each year. Most people who die from injuries do so before they are transported to hospital. Thus, reliable, pragmatic, and evidence-based prehospital guidance for various injuries is essential. We systematically mapped and described prehospital clinical practice guidelines (CPGs) for injuries in the global context, as well as prioritised injury topics for guidance development and adolopment. METHODS This study was sequentially conducted in three phases: a scoping review for CPGs (Phase I), identification and refinement of gaps in CPGs (Phase II), and ranking and prioritisation of gaps in CPGs (Phase III). For Phase I, we searched PubMed, SCOPUS, and Trip Database; guideline repositories and websites up to 23rd May 2021. Two authors in duplicate independently screened titles and abstract, and full-text as well as extracted data of eligible CPGs. Guidelines had to meet 60% minimum methodological quality according to rigour of development domain in AGREE II. The second and third phases involved 17 participants from 9 African countries and 1 from Europe who participated in a virtual stakeholder engagement workshop held on 5 April 2022, and followed by an online ranking process. RESULTS Fifty-eight CPGs were included out of 3,427 guidance documents obtained and screened. 39/58 (67%) were developed de novo compared to 19 that were developed using alternative approaches. Twenty-five out of 58 guidelines (43%) were developed by bodies in countries within the WHO European Region, while only one guideline was targeted to the African context. Twenty-five (43%) CPGs targeted emergency medical service providers, while 13 (22%) targeted first aid providers (laypeople). Forty-three CPGs (74%) targeted people of all ages. The 58 guidance documents contained 32 injury topics. Injuries linked to road traffic accidents such as traumatic brain injuries and chest injuries were among the top prioritised topics for future guideline development by the workshop participants. CONCLUSION This study highlights the availability, gaps and priority injury topics for future guideline development/adolopment, especially for the African context. Further research is needed to evaluate the recommendations in the 58 included CPGs for possible adaptation to the African context.
Collapse
Affiliation(s)
- Desmond Kuupiel
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa.
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa.
- Faculty of Health Sciences, Durban University of Technology, Durban, 4001, South Africa.
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.
| | - Nasreen S Jessani
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Jody Boffa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa
- The Aurum Institute, Johannesburg, South Africa
| | - Celeste Naude
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Motstraat 42, 2800, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35 block D, 3000, Leuven, Belgium
- Cochrane First Aid, Motstraat 42, Mechelen, Belgium
| | - Philippe Vandekerckhove
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35 block D, 3000, Leuven, Belgium
- Belgian Red Cross, Motstraat 42, 2800, Mechelen, Belgium
| | - Michael McCaul
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa
| |
Collapse
|
23
|
Jeon S, Baik J, Kim J, Lee J, Do W, Kim E, Lee HJ, Kim H. Intrathecal dexmedetomidine attenuates mechanical allodynia through the downregulation of brain-derived neurotrophic factor in a mild traumatic brain injury rat model. Korean J Anesthesiol 2023; 76:56-66. [PMID: 35760392 PMCID: PMC9902181 DOI: 10.4097/kja.22209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/23/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study evaluated the effects of dexmedetomidine and propofol on brain-derived neurotrophic factor level in the cerebrospinal fluid (c-BDNF) and mechanical allodynia in a mild traumatic brain injury (TBI) rat model. METHODS After fixing the rat's skull on a stereotactic frame under general anesthesia, craniotomy was performed. After impact, 10 µl of drug was injected into the cisterna magna (group S: sham, group D: dexmedetomidine 5 μg/kg, group P: propofol 500 μg/kg, and group T: untreated TBI). The 50% mechanical withdrawal threshold (50% MWT) and c-BDNF level were measured on postoperative days (PODs) 1, 7, and 14. RESULTS The 50% MWT measured on PODs 1, 7, and 14 was lower and the c-BDNF level on POD 1 was higher in group T than in group S. In group D, the c-BDNF level on POD 1 was lower than that in group T and was comparable with that in group S during the whole study period. The 50% MWT of group D was higher than that of group T throughout the postoperative period. In group P, there were no significant differences in the 50% MWT during the entire postoperative period compared with group T; the c-BDNF level was higher than that in group T on POD 1. CONCLUSIONS Intrathecal administration of dexmedetomidine may attenuate TBI-induced mechanical allodynia for up to two weeks post-injury through immediate suppression of c-BDNF in mild TBI rats. The inhibition of c-BDNF expression in the acute phase reduced the occurrence of TBI-induced chronic neuropathic pain.
Collapse
Affiliation(s)
- Soeun Jeon
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Institute for Translational Research in Dentistry, Kyungpook National University, Daegu, Korea
| | - Jiseok Baik
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea,Pusan National University School of Medicine, Busan, Korea,Corresponding author: Jiseok Baik, M.D., Ph.D., Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, KoreaTel: +82-51-240-7399Fax: +82-51-242-7466
| | - Jisu Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jiyoon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Wangseok Do
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eunsoo Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea,Pusan National University School of Medicine, Busan, Korea
| | - Hyeon Jeong Lee
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea,Pusan National University School of Medicine, Busan, Korea
| | - Haekyu Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea,Pusan National University School of Medicine, Busan, Korea
| |
Collapse
|
24
|
Qin J, Chen X, Wang R, Tian Z, Li Y, Shu S. Reactive oxygen species-responsive HET0016 prodrug-loaded liposomes attenuate neuroinflammation and improve neurological deficit in a rat model of juvenile traumatic brain injury. Front Neurosci 2023; 17:1153349. [PMID: 37034179 PMCID: PMC10073507 DOI: 10.3389/fnins.2023.1153349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
The arachidonic acid pathway metabolite 20-hydroxyeicosatetraenoic acid (20-HETE) contributes to ischemia/reperfusion brain injury. Inhibition of 20-HETE formation can protect the developing brain from global ischemia. In previous studies, we have found that treatment with the 20-HETE synthesis inhibitor N-hydroxy-N-4-butyl-2-methylphenylformamidine (HET0016) can protect the immature brain from traumatic brain injury (TBI), but its hydrophobic nature limits its full potential. We designed a reactive oxygen species-responsive HET0016 prodrug, which consists of a thioketal link between HET0016 and stearyl alcohol (HET-TK-SA), and used the nanoprodrug strategy to successfully synthesize liposomes HET0016 prodrug liposomes (HPLs) to facilitate the application of HET0016 in protection from TBI. HPLs demonstrated spherical shape, size of about 127.8 nm, a zeta potential of -28.8 mv, a narrow particle size distribution and good stability. Male rats at postnatal day 16-17 underwent controlled cortical impact (CCI) followed by intravenous injection with vehicle or HET0016 (1 mg/kg, 2 h post-injury, once/day for 3 days). The results of the in vivo demonstrated that HPLs has good biosafety and can pass through the blood-brain barrier. Not only that compared with HET0016, HPLs better-inhibited inflammation and improved neuronal degeneration, which further led to lesion volume reduction, upgraded behavioral task performance, and ameliorated the degree of TBI impairment. Our results demonstrated HPLs could be a new strategy for juvenile TBI therapy.
Collapse
Affiliation(s)
- Jun Qin
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoli Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Wang
- College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Zedan Tian
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Li
- College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Shiyu Shu
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Shiyu Shu,
| |
Collapse
|
25
|
Tang B, Zhong Z, Wu J, Ma J, Li L, Zhong X, Lin D, Hu J, Yu P. Evaluation of Serum NLRC4 as a Potential Prognostic Biochemical Marker in Humans with Severe Traumatic Brain Injury: A Prospective Cohort Study. Risk Manag Healthc Policy 2023; 16:439-454. [PMID: 36994425 PMCID: PMC10042254 DOI: 10.2147/rmhp.s404877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Objective Involvement of NLR CARD domain containing 4 (NLRC4) in neuroinflammation has been demonstrated. The aim of this study was to ascertain the prognostic role of serum NLRC4 in severe traumatic brain injury (sTBI). Methods In this prospective cohort study including 140 sTBI patients and 140 controls, serum NLRC4 levels were quantified. Follow-up time was 180 days after trauma and poor prognosis was designated as extended Glasgow outcome scale (GOSE) scores of 1-4. Severity correlations and prognosis associations were determined under multivariate models. Results Enhanced serum NLRC4 levels after sTBI, in comparison to controls (median, 0.8 ng/mL versus 0.1 ng/mL; P < 0.001), were independently correlated with Glasgow coma scale (GCS) scores (β, -0.091; 95% confidence interval (CI), -0.161-0.021; P = 0.011), Rotterdam computed tomography (CT) scores (β, 0.136; 95% CI, 0.024-0.248; P = 0.018), serum C-reactive protein levels (β, 0.016; 95% CI, 0.002-0.030; P = 0.025) and 180-day GOSE scores (β, -0.906; 95% CI, -1.632-0.180; P = 0.015); and were independently predictive of 180-day death (odds ratio, 4.307; 95% CI, 1.706-10.879; P = 0.014)), overall survival (hazard ratio, 2.360; 95% CI, 1.118-4.981; P = 0.040) and poor prognosis (odds ratio, 6.705; 95% CI, 2.889-15.561; P = 0.016). Under receiver operating characteristic curve, combination of serum NLRC4 levels, GCS scores and Rotterdam CT scores had significantly higher death predictive ability than Rotterdam CT scores (P = 0.040), but not than GCS scores (P = 0.070); and exhibited substantially higher predictive capability for poor prognosis than Rotterdam CT scores (P < 0.001) and GCS scores alone (P = 0.023). Conclusion There is a dramatical elevation of serum NLRC4 levels after sTBI, which has strong correlation with severity and inflammation, and is significantly associated with long-term death and poor outcome, substantializing serum NLRC4 as an inflammatory, prognostic biomarker in sTBI.
Collapse
Affiliation(s)
- Bei Tang
- Department of Critical Care Medicine, The First People’s Hospital of Jiande City, Jiande, People’s Republic of China
| | - Ze Zhong
- Department of Critical Care Medicine, The First People’s Hospital of Jiande City, Jiande, People’s Republic of China
- Correspondence: Ze Zhong, Department of Critical Care Medicine, The First People’s Hospital of Jiande City, Jiande, People’s Republic of China, Tel/Fax +86 571 64096607, Email
| | - Jinping Wu
- Department of Critical Care Medicine, The First People’s Hospital of Jiande City, Jiande, People’s Republic of China
| | - Jianping Ma
- Department of Critical Care Medicine, The First People’s Hospital of Jiande City, Jiande, People’s Republic of China
| | - Li Li
- Department of Critical Care Medicine, The First People’s Hospital of Jiande City, Jiande, People’s Republic of China
| | - Xuzheng Zhong
- Department of Critical Care Medicine, The First People’s Hospital of Jiande City, Jiande, People’s Republic of China
| | - Dongmei Lin
- Department of Critical Care Medicine, The First People’s Hospital of Jiande City, Jiande, People’s Republic of China
| | - Jiayuan Hu
- Department of Critical Care Medicine, The First People’s Hospital of Jiande City, Jiande, People’s Republic of China
| | - Pingan Yu
- Department of Critical Care Medicine, The First People’s Hospital of Jiande City, Jiande, People’s Republic of China
| |
Collapse
|
26
|
Gelormini C, Caricato A, Pastorino R, Guerino Biasucci D, Ioannoni E, Montano N, Stival E, Signorelli F, Melchionda I, Albanese A, Marchese E, Silva S, Antonelli M. Brain tissue oxygenation monitoring in subarachnoid hemorrhage for the detection of delayed ischemia: a systematic review and meta-analysis. Minerva Anestesiol 2023; 89:96-103. [PMID: 36745118 DOI: 10.23736/s0375-9393.22.16468-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Subarachnoid hemorrhage (SAH) is a severe subtype of stroke which can be caused by the rupture of an intracranial aneurysm. Following SAH, about 30% of patients develop a late neurologic deterioration due to a delayed cerebral ischemia (DCI). This is a metanalysis and systematic review on the association between values of brain tissue oxygenation (PbtO2) and DCI in patients with SAH. EVIDENCE ACQUISITION The protocol was written according to the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and approved by the International Prospective Register of Systematic Reviews (PROSPERO registration number CRD42021229338). Relevant literature published up to August 1, 2022 was systematically searched throughout the databases MEDLINE, WEB OF SCIENCE, SCOPUS. A systematic review and metanalysis was carried out. The studies considered eligible were those published in English; that enrolled adult patients (≥18years) admitted to neurointensive care units with aneurysmal SAH (aSAH); that reported presence of multimodality monitoring including PbtO2 and detection of DCI during the period of monitoring. EVIDENCE SYNTHESIS We founded 286 studies, of which six considered eligible. The cumulative mean of PbtO2 was 19.5 mmHg in the ischemic group and 24.1mmHg in the non ischemic group. The overall mean difference of the values of PbtO2 between the patients with or without DCI resulted significantly different (-4.32 mmHg [IC 95%: -5.70, -2.94], without heterogeneity, I2 = 0%, and a test for overall effect with P<0.00001). CONCLUSIONS PbtO2 values were significantly lower in patients with DCI. Waiting for definitive results, monitoring of PbtO2 should be considered as a complementary parameter for multimodal monitoring of the risk of DCI in patients with SAH.
Collapse
Affiliation(s)
- Camilla Gelormini
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Anselmo Caricato
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Roberta Pastorino
- Department of Woman, Child, and Public Health, Gemelli University Hospital IRCCS, Rome, Italy
| | - Daniele Guerino Biasucci
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Eleonora Ioannoni
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Nicola Montano
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Eleonora Stival
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Francesco Signorelli
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Isabella Melchionda
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Alessio Albanese
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Enrico Marchese
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Serena Silva
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Massimo Antonelli
- Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| |
Collapse
|
27
|
Ito H, Nakamura Y, Togami Y, Onishi S, Nakao S, Iba J, Ogura H, Oda J. Association of Extravascular Leakage on Computed Tomography Angiography with Fibrinogen Levels at Admission in Patients with Traumatic Brain Injury. Neurotrauma Rep 2022; 4:3-13. [PMID: 36636245 PMCID: PMC9811953 DOI: 10.1089/neur.2022.0054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Extravascular leakage on computed tomography (CT) angiography in patients with traumatic brain injury (TBI) is associated with hematoma expansion, functional prognosis, subsequent surgery, and death. Fresh frozen plasma (FFP) administration is often necessary to treat coagulation disorders associated with TBI. This study aimed to determine the relationship between the presence of extravascular leakage on contrast-enhanced head CT, fibrinogen level at admission, and FFP administration in patients with TBI. The medical records of patients with TBI ≥18 years of age referred to our hospital between January 2010 and December 2020 were examined retrospectively. Patients who underwent contrast-enhanced CT immediately after admission were selected, and the presence or absence of extravascular leakage, fibrinogen level at admission, and percentage of patients who required FFP administration within 24 h of admission were examined; 172 patients were included. Multi-variable linear regression analysis was performed to determine the effects of contrast extravasation on fibrinogen levels at admission and was adjusted for age, sex, systolic blood pressure, time from injury to admission, Marshall CT score, Glasgow Coma Scale score at admission, Injury Severity Score, and need for emergency surgery; the regression coefficient was -19.8. The effect of extravasation on FFP administration within 24 h of admission was analyzed using logistic regression while adjusting for age, systolic blood pressure, Marshall CT score, need for emergency surgery, and fibrinogen level at admission. The odds ratio of contrast extravasation was 7.08 after adjustment. Extravascular leakage is associated with fibrinogen levels at admission and FFP administration within 24 h of admission.
Collapse
Affiliation(s)
- Hiroshi Ito
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.,Address correspondence to: Hiroshi Ito, PhD, Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Osaka 565-0871, Japan;
| | - Youhei Nakamura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Togami
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinya Onishi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jiro Iba
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
28
|
Planquart F, Marcaggi E, Blondonnet R, Clovet O, Bobbia X, Boussat B, Pottecher J, Gauss T, Zieleskiewicz L, Bouzat P. Appropriateness of Initial Course of Action in the Management of Blunt Trauma Based on a Diagnostic Workup Including an Extended Ultrasonography Scan. JAMA Netw Open 2022; 5:e2245432. [PMID: 36477480 PMCID: PMC9856525 DOI: 10.1001/jamanetworkopen.2022.45432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE The extended Focused Assessment With Sonography for Trauma (E-FAST) has become a cornerstone of the diagnostic workup in patients with trauma. The added value of a diagnostic workup including an E-FAST to support decision-making remains unknown. OBJECTIVE To determine how often an immediate course of action adopted in the resuscitation room based on a diagnostic workup that included an E-FAST and before whole-body computed tomography scanning (WBCT) in patients with blunt trauma was appropriate. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted at 6 French level I trauma centers between November 5, 2018, and November 5, 2019. Consecutive patients treated for blunt trauma were assessed at the participating centers. Data analysis took place in February 2022. EXPOSURES Diagnostic workup associating E-FAST (including abdominal, thoracic, pubic, and transcranial Doppler ultrasonography scan), systematic clinical examination, and chest and pelvic radiographs. MAIN OUTCOMES AND MEASURES The main outcome criterion was the appropriateness of the observed course of action (including abstention) in the resuscitation room according to evaluation by a masked expert panel. RESULTS Of 515 patients screened, 510 patients (99.0%) were included. Among the 510 patients included, 394 were men (77.3%), the median (IQR) age was 46 years (29-61 years), and the median (IQR) Injury Severity Score (ISS) was 24 (17-34). Based on the initial diagnostic workup, no immediate therapeutic action was deemed necessary in 233 cases (45.7%). Conversely, the following immediate therapeutic actions were initiated before WBCT: 6 emergency laparotomies (1.2%), 2 pelvic angioembolisations (0.4%), 52 pelvic binders (10.2%), 41 chest drains (8.0%) and 16 chest decompressions (3.1%), 60 osmotherapies (11.8%), and 6 thoracotomies (1.2%). To improve cerebral blood flow based on transcranial doppler recordings, norepinephrine was initiated in 108 cases (21.2%). In summary, the expert panel considered the course of action appropriate in 493 of 510 cases (96.7%; 95% CI, 94.7%-98.0%). Among the 17 cases (3.3%) with inappropriate course of action, 13 (76%) corresponded to a deviation from existing guidelines and 4 (24%) resulted from an erroneous interpretation of the E-FAST. CONCLUSIONS AND RELEVANCE This prospective, multicenter cohort study found that a diagnostic resuscitation room workup for patients with blunt trauma that included E-FAST with clinical assessment and targeted chest and pelvic radiographs was associated with the determination of an appropriate course of action prior to WBCT.
Collapse
Affiliation(s)
- Fanny Planquart
- Service d’Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | | | - Raiko Blondonnet
- Pôle de Médecine Périopératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Clovet
- Département d’Anesthésie-Réanimation et Médecine Péri-Opératoire, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Xavier Bobbia
- Université de Montpellier, Département Urgences CHU Montpellier, Montpellier, France
| | - Bastien Boussat
- Service d’épidémiologie et évaluation médicale, CHU Grenoble-Alpes, laboratoire TIMC-IMAG, UMR 5525 Joint Research Unit, Centre National de Recherche Scientifique, Université Grenoble-Alpes, France
| | - Julien Pottecher
- Service d’Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
- Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, UR3072, Strasbourg, France
| | - Tobias Gauss
- Pôle d’Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Laurent Zieleskiewicz
- Service d’anesthésie réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, Centre de recherche en Cardiovasculaire et Nutrition, Aix-Marseille Université, France
| | - Pierre Bouzat
- University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| |
Collapse
|
29
|
Wang X, He Q, Ma L, You C. Comparison of different concentrations of hypertonic saline in patients with traumatic brain injury: Evidence from direct and indirect comparisons. Injury 2022; 53:3729-3735. [PMID: 36114014 DOI: 10.1016/j.injury.2022.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/20/2022] [Accepted: 08/28/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Until now, it has remained difficult for doctors to make an informative decision as to which concentration of hypertonic saline (HTS) is more beneficial for patients with traumatic brain injury (TBI). We therefore investigate the effect of different concentrations of hypertonic saline on mortality and ICP lowering efficacy in this group of patients. METHODS Several databases including Ovid MEDLINE, Ovid EMBASE, PubMed, and Cochrane Central Register of Controlled Trials were searched comprehensively from inception to February 28, 2022. We only included RCTs that compared HTS with different concentrations and mannitol in adult patients with TBI. The main outcome was mortality from any cause. We reported relative risks (RR) and 95% confidence intervals (CIs) from direct meta-analysis and 95% credible intervals (CrIs) from network meta-analysis. RESULTS Overall, 13 trials containing 593 patients were included in this study. Direct analysis revealed that HTS was associated with decreased risk of all-cause mortality (RR, 1.29; 95% CI: 1.08 to 1.54). In the network meta-analysis, 5% HTS was associated with a significant decrease in all-cause mortality compared with mannitol (RR 0.34, 95% CrI: 0.14 to 0.72). We also found 7.5% HTS was associated with a significant increase in all-cause mortality compared with 5% HTS (RR, 2.87; 95% CrI: 1.00 to 8.99). CONCLUSIONS Among patients with TBI, the application of 5% HTS was associated with decreased all-cause mortality compared with mannitol and other concentration. Treatments with 10% and 15% HTS was more likely to decrease ICP compared with other fluids. More trials are needed to verify the current findings.
Collapse
Affiliation(s)
- Xing Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, No.37, St. Guoxuexiang, Chengdu, Sichuan 610041, China
| | - Qiang He
- Department of Neurosurgery, West China Hospital, Sichuan University, No.37, St. Guoxuexiang, Chengdu, Sichuan 610041, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, No.37, St. Guoxuexiang, Chengdu, Sichuan 610041, China.
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, No.37, St. Guoxuexiang, Chengdu, Sichuan 610041, China; West China Brain Research Centre, Sichuan University, Chengdu, Sichuan 610041, China.
| |
Collapse
|
30
|
Association of In-Hospital Mortality and Trauma Team Activation: A 10-Year Study. Diagnostics (Basel) 2022; 12:diagnostics12102334. [PMID: 36292022 PMCID: PMC9600103 DOI: 10.3390/diagnostics12102334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Early trauma team activation (TTA) may improve clinical outcomes through early diagnosis and timely intervention by a dedicated multidisciplinary team. Controversy seems to exist about the effect of establishing trauma team systems in traumatic injury populations. Our aim was to identify factors that may be associated with clinical outcomes in trauma injury and to investigate the effect of trauma team activation. Method: This retrospective descriptive study included all traumatic patients from the Taipei Tzu Chi Hospital Trauma Database. All prehospital vital signs, management, injury type, injury mechanisms, hospitalization history, and clinical outcomes were analyzed, and multivariable logistic regression was used to investigate the association between trauma team activation and clinical outcomes. Subgroups of TTA in minor injury and non-TTA in major injury were also analyzed. Result: In this study, a total of 11,946 patients were included, of which 10,831 (90.7%) patients were minor injury (ISS < 16), and 1115 (9.3%) patients were major injury (ISS ≥ 16). In the minor injury population, TTA had a higher intensive care unit (ICU) admission rate, operation rate, re-operation rate, and prolonged total length of stay (LOS). In the major injury population, TTA had a higher mortality rate, prolonged total LOS, and prolonged ICU LOS. After adjusting for mechanism of injury and injury severity, there was no association between in-hospital mortality and TTA, compared with the non-TTA group. However, the TTA group had a higher risk of ICU admission, prolonged ICU LOS, and prolonged total LOS. The subgroup analysis showed trauma team activation had a higher risk of mortality in the 60- to 80-year-old population, major injury (ISS ≥ 16), consciousness clear population, and non-head injury group. Conclusions: We found there was no significant association between in-hospital mortality and TTA. However, in the TTA group, there was a higher risk of ICU admission, prolonged total, LOS, and prolonged ICU LOS. In the subgroup analysis, TTA had a higher risk of mortality in the 60- to 80-year-old population, major injury (ISS ≥ 16), consciousness clear population, and non-head injury group. Our results reflect TTA-criteria-selected patients with greater ISS and a high risk of mortality.
Collapse
|
31
|
Jacquens A, Needham EJ, Zanier ER, Degos V, Gressens P, Menon D. Neuro-Inflammation Modulation and Post-Traumatic Brain Injury Lesions: From Bench to Bed-Side. Int J Mol Sci 2022; 23:ijms231911193. [PMID: 36232495 PMCID: PMC9570205 DOI: 10.3390/ijms231911193] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Head trauma is the most common cause of disability in young adults. Known as a silent epidemic, it can cause a mosaic of symptoms, whether neurological (sensory-motor deficits), psychiatric (depressive and anxiety symptoms), or somatic (vertigo, tinnitus, phosphenes). Furthermore, cranial trauma (CT) in children presents several particularities in terms of epidemiology, mechanism, and physiopathology-notably linked to the attack of an immature organ. As in adults, head trauma in children can have lifelong repercussions and can cause social and family isolation, difficulties at school, and, later, socio-professional adversity. Improving management of the pre-hospital and rehabilitation course of these patients reduces secondary morbidity and mortality, but often not without long-term disability. One hypothesized contributor to this process is chronic neuroinflammation, which could accompany primary lesions and facilitate their development into tertiary lesions. Neuroinflammation is a complex process involving different actors such as glial cells (astrocytes, microglia, oligodendrocytes), the permeability of the blood-brain barrier, excitotoxicity, production of oxygen derivatives, cytokine release, tissue damage, and neuronal death. Several studies have investigated the effect of various treatments on the neuroinflammatory response in traumatic brain injury in vitro and in animal and human models. The aim of this review is to examine the various anti-inflammatory therapies that have been implemented.
Collapse
Affiliation(s)
- Alice Jacquens
- Unité de Neuroanesthésie-Réanimation, Hôpital de la Pitié Salpêtrière 43-87, Boulevard de l’Hôpital, F-75013 Paris, France
- Inserm, Maladies Neurodéveloppementales et Neurovasculaires, Université Paris Cité, F-75019 Paris, France
- Correspondence: ; Tel.: +33-1-42-16-00-00
| | - Edward J. Needham
- Division of Anaesthesia, Addenbrooke’s Hospital, University of Cambridge, Box 93, Hills Road, Cambridge CB2 2QQ, UK
| | - Elisa R. Zanier
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Vincent Degos
- Unité de Neuroanesthésie-Réanimation, Hôpital de la Pitié Salpêtrière 43-87, Boulevard de l’Hôpital, F-75013 Paris, France
- Inserm, Maladies Neurodéveloppementales et Neurovasculaires, Université Paris Cité, F-75019 Paris, France
| | - Pierre Gressens
- Inserm, Maladies Neurodéveloppementales et Neurovasculaires, Université Paris Cité, F-75019 Paris, France
| | - David Menon
- Division of Anaesthesia, Addenbrooke’s Hospital, University of Cambridge, Box 93, Hills Road, Cambridge CB2 2QQ, UK
| |
Collapse
|
32
|
Campassi ML, Repetto FG, Banegas Litardo DM, Castor R, Gómez G, Tiseyra B, Flores L, Ramirez I, Maspoli D, Báez J, Boroni I, Bertola R, Estenssoro E, Dubin A. Incidence and determinats of augmented renal clearance in traumatic brain injury: A prospective observational study. J Crit Care 2022; 70:154065. [DOI: 10.1016/j.jcrc.2022.154065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/29/2022]
|
33
|
de Courson H, Proust-Lima C, Tuaz E, Georges D, Verchère E, Biais M. Relationship Between Brain Tissue Oxygen and Near-Infrared Spectroscopy in Patients with Nontraumatic Subarachnoid Hemorrhage. Neurocrit Care 2022; 37:620-628. [PMID: 35876962 DOI: 10.1007/s12028-022-01563-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Continuous monitoring of cerebral oxygenation is one of the diagnostic tools used in patients with brain injury. Direct and invasive measurement of cerebral oxygenation with a partial brain oxygen pressure (PbtO2) probe is promising but invasive. Noninvasive assessment of regional transcranial oxygen saturation using near-infrared spectroscopy (NIRS) may be feasible. The aim of this study was to evaluate the interchangeability between PbtO2 and NIRS over time in patients with nontraumatic subarachnoid hemorrhage. METHODS This retrospective study was performed in a neurocritical care unit. Study participants underwent hourly PbtO2 and NIRS measurements over 72 h. Temporal agreement between markers was described by their pointwise correlation. A secondary analysis assessed the structure of covariation between marker trajectories using a bivariate linear mixed model. RESULTS Fifty-one patients with subarachnoid hemorrhage were included. A total of 3362 simultaneous NIRS and PbtO2 measurements were obtained. The correlation at each measurement time ranged from - 0.25 to 0.25. The global correlation over time was - 0.026 (p = 0.130). The bivariate linear mixed model confirmed the lack of significant correlation between the PbtO2 and NIRS measurements at follow-up. NIRS was unable to detect PbtO2 values below 20 mm Hg (area under the receiver operating characteristic curve 0.539 [95% confidence interval 0.536-0.542]; p = 0.928), and percentage changes in NIRS were unable to detect a decrease in PbtO2 ≥ 10% (area under the receiver operating characteristic curve 0.615 [95% confidence interval 0.614-0.616]; p < 0.001). CONCLUSIONS PbtO2 and NIRS measurements were not correlated. There is no evidence that NIRS could be a substitute for PbtO2 monitoring in patients with nontraumatic subarachnoid hemorrhage.
Collapse
Affiliation(s)
- Hugues de Courson
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France.,U1219, Bordeaux Population Health, Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France
| | - C Proust-Lima
- U1219, Bordeaux Population Health, Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France
| | - Estelle Tuaz
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Delphine Georges
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Eric Verchère
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Matthieu Biais
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France. .,U1034, Biology of Cardiovascular Diseases, Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France.
| |
Collapse
|
34
|
Mortality and Risk Factors in Isolated Traumatic Brain Injury Patients: A Prospective Cohort Study. J Surg Res 2022; 279:480-490. [PMID: 35842973 DOI: 10.1016/j.jss.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/17/2022] [Accepted: 05/21/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Outcomes in patients with isolated traumatic brain injury (iTBI) have not been evaluated comprehensively in low-income and middle-income countries. We aimed to study the in-hospital iTBI mortality and its associated risk factors in a prospective multicenter Indian trauma registry. METHODS Patients with iTBI (head and neck Abbreviated Injury Score ≥2 and other region Abbreviated Injury Score ≤2) were included. Study variables comprised age, gender, mechanism of injury, systolic blood pressure (SBP) at arrival, Glasgow Coma Scale (GCS) score - classified as mild (13-15), moderate (9-12), and severe (3-8), transfer status, and time to presentation at any participating hospital. A multivariable logistic regression was performed to assess the impact of these factors on 24-h and 30-d mortality following iTBI. RESULTS Among 5042 included patients, 24-h and 30-d in-hospital mortalities were 5.9% and 22.4%. On a regression analysis, 30-d mortality was associated with age ≥45 y (odds ratio [OR] = 2.1 [1.6-2.7]), railway injury mechanisms (OR = 2.1 [1.3-3.5]), SBP <90 mmHg (OR = 2.6 [1.6-4.1]), and moderate (OR = 3.8 [3.0-5.0]) to severe (OR = 21.1 [16.8-26.7]) iTBI based on GCS scores. 24-h mortality showed similar trends. Patients transferred to the participating hospitals from other centers had higher odds of 30-d mortality (OR = 1.4 [1.2-1.8]) compared to those arriving directly. Those who received neurosurgical intervention had lower odds of 24-h mortality (0.3 [0.2-0.4]). CONCLUSIONS Age ≥45 y, GCS score ≤12, and SBP <90 mmHg at arrival increased the risk of in-hospital mortality from iTBI.
Collapse
|
35
|
Gauss T, Quintard H, Bijok B, Bouhours G, Clavier T, Cook F, de Courson H, David JS, Duracher-Gout C, Garrigue D, Geeraerts T, Hamada S, Joannes-Boyau O, Jouffroy R, Lamblin A, Langeron O, Lanot P, Lasocki S, Leone M, Mirek S, Muller L, Pasquier P, Prunet B, Perbet S, Raux M, Richards J, Roger C, Roquilly A, Weiss E, Bouzat P, Pottecher J. Intrahospital trauma flowcharts - Cognitive aids for intrahospital trauma management from the French Society of Anaesthesia and Intensive Care Medicine (SFAR) and the French Society of Emergency Medicine (SFMU). Anaesth Crit Care Pain Med 2022; 41:101069. [PMID: 35470051 DOI: 10.1016/j.accpm.2022.101069] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Tobias Gauss
- Anaesthesia-Critical Care, Grenoble Alpes University Hospital, Grenoble, France.
| | - Hervé Quintard
- Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland
| | - Benjamin Bijok
- Pôle d'anesthésie-réanimation, Pôle de l'Urgence, Lille University Hospital, Lille, France
| | - Guillaume Bouhours
- Département d'anesthésie-réanimation, LUNAM Université, Université d'Angers, CHU d'Angers, Angers, France
| | - Thomas Clavier
- Department of Anaesthesia and Intensive Care, Rouen University Hospital, Rouen, France
| | - Fabrice Cook
- Intensive Care Unit, Cayenne General Hospital, Cayenne, French Guiana, France
| | - Hugues de Courson
- Department of Anaesthesiology, Critical Care, Bordeaux University Hospital, Univ. Bordeaux, INSERM, BPH, U1219, France
| | - Jean-Stéphane David
- Anaesthesia-Critical Care, Groupe Hospitalier Sud, Hospices Civils de Lyon, Faculté de Médecine Lyon Est, Lyon University, Lyon, France
| | - Caroline Duracher-Gout
- Département d'Anesthésie Réanimation Chirurgicale et SAMU de Paris, Université René Descartes Paris, Paris, France
| | - Delphine Garrigue
- Pôle d'anesthésie-réanimation, Pôle de l'Urgence, Lille University Hospital, Lille, France
| | - Thomas Geeraerts
- Department of Anaesthesia and Critical Care Medicine, Toulouse University Hospital, Toulouse, France
| | - Sophie Hamada
- Anesthésie Réanimation, Hôpital Européen Georges Pompidou APHP, Université de Paris, and CESP, INSERM U 10-18, Université Paris-Saclay, Paris, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Romain Jouffroy
- Intensive Care Unit, Ambroise Paré Hospital, AP-HP, Centre de recherche en Epidémiologie et Santé des Populations - U1018 INSERM, Paris Saclay University, Boulogne Billancourt, France
| | - Antoine Lamblin
- Services Anesthésie-Réanimaton, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Olivier Langeron
- Department of Anaesthesia and Intensive Care, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - Pierre Lanot
- Anaesthesia and Critical Care, Hôpital Privé Antony, Antony, France
| | - Sigismond Lasocki
- Département d'anesthésie-réanimation, LUNAM Université, Université d'Angers, CHU d'Angers, Angers, France
| | - Marc Leone
- Department of Anaesthesia and Intensive Care, Hôpital Nord Aix Marseille, AP-HM, Aix Marseille University, Marseille, France
| | | | - Laurent Muller
- Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes Caremeau, Nîmes, France
| | - Pierre Pasquier
- Département anesthésie-réanimation, Hôpital d'instruction des armées Percy, Clamart, France; Brigade de Sapeurs-Pompiers de Paris, Paris, France
| | - Bertrand Prunet
- Ecole du Val de Grâce, Brigade de Sapeurs-Pompiers de Paris, Paris, France
| | - Sébastien Perbet
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Université Clermont Auvergne, CNRS, Inserm, GReD, Clermont-Ferrand, France
| | - Mathieu Raux
- Département d'Anesthésie Réanimation, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Justin Richards
- Department of Anaesthesiology, University of Maryland School of Medicine, Divisions of Trauma Anaesthesiology and Critical Care Medicine, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Claire Roger
- Pôle Anesthésie Réanimation Douleur Urgence, CHU Carémeau, Nîmes, France
| | - Antoine Roquilly
- Pôle Anesthésie-Réanimation, CHU Nantes, Université de Nantes, Nantes, France
| | - Emmanuel Weiss
- Anaesthesia and Critical Care, Beaujon University Hospital, DMU PARABOL, AP-HP. Nord, UMR_S1149, Paris, France
| | - Pierre Bouzat
- Anaesthesia-Critical Care, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Pottecher
- Anaesthesia and Critical Care, Strasbourg University, FMTS/UR 3072, Strasbourg University Hospital, Strasbourg, France
| |
Collapse
|
36
|
Tazarourte K, Ageron FX, Avondo A, Barnard E, Bobbia X, Cesareo E, Chollet-Xemard C, Curac S, Desmettre T, Khoury CEL, Gauss T, Gil-Jardine C, Harris T, Heidet M, Lapostolle F, Pradeau C, Renard A, Sapir D, Tourtier JP, Travers S. Prehospital trauma flowcharts - Concise and visual cognitive aids for prehospital trauma management from the French Society of Emergency Medicine (SFMU) and the French Society of Anaesthesia and Intensive Care Medicine (SFAR). Anaesth Crit Care Pain Med 2022; 41:101070. [PMID: 35504522 DOI: 10.1016/j.accpm.2022.101070] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Karim Tazarourte
- Université Claude Bernard Lyon 1, INSERM U1290 (RESHAPE), 69003 Lyon, France; SAMU 69/Service des Urgences, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France.
| | | | - Aurélie Avondo
- Service des Urgences, Hôpital Ambroise Paré, APHP, Boulogne Billancourt 92000, France
| | - Edward Barnard
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Clinical Innovation), Birmingham, United Kingdom; Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Hangar E, Gambling Close, Norwich Airport, Norwich, United Kingdom
| | - Xavier Bobbia
- Faculté de médecine Montpellier/Nîmes, Montpellier 34000, France
| | - Eric Cesareo
- SAMU 69/Service des Urgences, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France
| | - Charlotte Chollet-Xemard
- Assistance-Publique-Hôpitaux de Paris (APHP), SAMU 94 et service des urgences, Hôpital Henri Mondor, Créteil 94000, France
| | - Sonja Curac
- Service d'urgences - SMUR Hital Erasme, Hôpitaux Universitaires de Bruxelles - HUB- 808 1070, Bruxelles, Belgique
| | - Thibaut Desmettre
- Université De Franche-Comté UMR 6249 CNRS UFC, 25000 Besançon, France; Pôle Urgences SAMU/médecin intensive CHU de Besançon, 25030 Besançon, France
| | - Carlos E L Khoury
- Service des urgences Medipôle, Hôpital mutualiste, Villeurbanne 69000, France
| | - Tobias Gauss
- Anesthésie-Réanimation, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Tim Harris
- Emergency Medicine, Blizzard institute, Queen Mary University London, United Kingdom; Department Emergency Medicine, Hamad Medical Corporation, Qatar
| | - Matthieu Heidet
- Assistance-Publique-Hôpitaux de Paris (APHP), SAMU 94 et service des urgences, Hôpital Henri Mondor, Créteil 94000, France; Université Paris-Est Créteil (UPEC), EA 3956 (CIR), Créteil 94000, France
| | - Frédéric Lapostolle
- UF Recherche-Enseignement-Qualité, Hôpital Avicenne, AP-HP, Université Paris, Urgences - Samu 93, 13, Inserm U942, 93000, Bobigny, France
| | | | - Aurélien Renard
- Service médical du Bataillon des marins Pompiers, 13003 Marseille, France
| | - David Sapir
- SAMU 77- département de médecine d'urgence, GHSIF Centre hospitalier de Melun 77000, France
| | | | - Stéphane Travers
- Ecole de santé du Val-de-Grâce Paris, Service Médical de la brigade des sapeurs-pompiers de Paris, Paris 75000, France
| |
Collapse
|
37
|
Management of moderate to severe traumatic brain injury: an update for the intensivist. Intensive Care Med 2022; 48:649-666. [PMID: 35595999 DOI: 10.1007/s00134-022-06702-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/09/2022] [Indexed: 01/04/2023]
Abstract
Traumatic brain injury (TBI) remains one of the most fatal and debilitating conditions in the world. Current clinical management in severe TBI patients is mainly concerned with reducing secondary insults and optimizing the balance between substrate delivery and consumption. Over the past decades, multimodality monitoring has become more widely available, and clinical management protocols have been published that recommend potential interventions to correct pathophysiological derangements. Even while evidence from randomized clinical trials is still lacking for many of the recommended interventions, these protocols and algorithms can be useful to define a clear standard of therapy where novel interventions can be added or be compared to. Over the past decade, more attention has been paid to holistic management, in which hemodynamic, respiratory, inflammatory or coagulation disturbances are detected and treated accordingly. Considerable variability with regards to the trajectories of recovery exists. Even while most of the recovery occurs in the first months after TBI, substantial changes may still occur in a later phase. Neuroprognostication is challenging in these patients, where a risk of self-fulfilling prophecies is a matter of concern. The present article provides a comprehensive and practical review of the current best practice in clinical management and long-term outcomes of moderate to severe TBI in adult patients admitted to the intensive care unit.
Collapse
|
38
|
Léger M, Frasca D, Roquilly A, Seguin P, Cinotti R, Dahyot-Fizelier C, Asehnoune K, Le Borgne F, Gaillard T, Foucher Y, Lasocki S. Early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort. PLoS One 2022; 17:e0268013. [PMID: 35507627 PMCID: PMC9067881 DOI: 10.1371/journal.pone.0268013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/20/2022] [Indexed: 01/29/2023] Open
Abstract
Barbiturates are proposed as a second/third line treatment for intracranial hypertension in traumatic brain injury (TBI) patients, but the literature remains uncertain regarding their benefit/risk balance. We aimed to evaluate the impact of barbiturates therapy in TBI patients with early intracranial hypertension on the intensive care unit (ICU) survival, the occurrence of ventilator-associated pneumonia (VAP), and the patient’s functional status at three months. We used the French AtlanREA prospective cohort of trauma patients. Using a propensity score-based methodology (inverse probability of treatment weighting), we compared patients having received barbiturates within the first 24 hours of admission (barbiturates group) and those who did not (control group). We used cause-specific Cox models for ICU survival and risk of VAP, and logistic regression for the 3-month Glasgow Outcome Scale (GOS) evaluation. Among the 1396 patients with severe trauma, 383 had intracranial hypertension on admission and were analyzed. Among them, 96 (25.1%) received barbiturates. The early use of barbiturates was significantly associated with increased ICU mortality (HR = 1.85, 95%CI 1.03–3.33). However, barbiturates treatment was not significantly associated with VAP (HR = 1.02, 95%CI 0.75–1.41) or 3-month GOS (OR = 1.67, 95%CI 0.84–3.33). Regarding the absence of relevant clinical trials, our results suggest that each early prescription of barbiturates requires a careful assessment of the benefit/risk ratio.
Collapse
Affiliation(s)
- Maxime Léger
- Département d’Anesthésie Réanimation, Centre Hospitalier Universitaire d’Angers, Angers, France
- INSERM UMR 1246—SPHERE, Nantes University, Tours University, Nantes, France
- * E-mail:
| | - Denis Frasca
- INSERM UMR 1246—SPHERE, Nantes University, Tours University, Nantes, France
- Département d’Anesthésie Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Antoine Roquilly
- Département d’Anesthésie Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Philippe Seguin
- Département d’Anesthésie Réanimation, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Raphaël Cinotti
- Département d’Anesthésie Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Claire Dahyot-Fizelier
- Département d’Anesthésie Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Karim Asehnoune
- Département d’Anesthésie Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Florent Le Borgne
- INSERM UMR 1246—SPHERE, Nantes University, Tours University, Nantes, France
- IDBC-A2COM, Pacé, France
| | - Thomas Gaillard
- Département d’Anesthésie Réanimation, Centre Hospitalier Universitaire d’Angers, Angers, France
| | - Yohann Foucher
- INSERM UMR 1246—SPHERE, Nantes University, Tours University, Nantes, France
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Sigismond Lasocki
- Département d’Anesthésie Réanimation, Centre Hospitalier Universitaire d’Angers, Angers, France
| | | |
Collapse
|
39
|
Denis M, Lauzier B, Roumeliotis N, Orliaguet G, Emeriaud G, Javouhey E, Brossier D. Severe Traumatic Brain Injury in French-Speaking Pediatric Intensive Care Units: Study of Practices. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1744298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractBest strategies for managing severe pediatric traumatic brain injury (TBI) are not established, with wide variations among professional practices. The main objective of this study was to assess compliance with updated pediatric TBI management guidelines (2019). A survey was distributed among French-speaking pediatric intensive care physicians from April 1 to June 30, 2019. The survey was based on a clinical case with a total of 70 questions that cover the 15 items of the 2019 TBI guidelines. The questions evaluated the assessment and management of TBI during the acute and intensive care phases. Of 487 e-mails sent, 78 surveys were included. Guidelines were adhered to (> 60%) for 10 of 15 items in the guidelines. Strong adherence to recent guideline changes was achieved for seizure prophylaxis with levetiracetam (n = 21/33, 64%) and partial pressure of carbon dioxide threshold (n = 52, 67%). However, management of the sodium and glucose thresholds and the role of transcranial Doppler were not consistent with the guidelines. Assessment of brain tissue oxygenation (n = 12, 16%) and autoregulation (n = 35, 45%) was not a common practice. There was strong agreement among clinicians on the intracranial pressure (> 80%) and cerebral perfusion pressure (> 70%) thresholds used according to age. Overall, stated practices for the management of TBI appear to be relatively standardized among responders. Variations persist in areas with a lack of evidence and pediatric-specific recommendations.
Collapse
Affiliation(s)
- Manon Denis
- Pediatric Intensive Care Unit, CHU de Caen, Caen, France
- Pediatric Intensive Care Unit, CHU de Nantes, Nantes, France
- Institut du thorax, INSERM, CNRS, Nantes Université, CHU de Nantes, France
- Institut du thorax, INSERM, CNRS, Nantes Université, France
| | | | - Nadia Roumeliotis
- Pediatric Intensive Care Unit, CHU Sainte Justine, Montréal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
| | - Gilles Orliaguet
- Surgical Pediatric Intensive Care Unit, Necker–Enfants Malades University Hospital, Paris, France
- Department of Pediatric and Obstetrical Anaesthesia and Intensive Care, Necker–Enfants Malades University Hospital, GHU AP-HP Centre - Université de Paris, Paris, France
- EA08 Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Université de Paris, Paris, France
| | - Guillaumes Emeriaud
- Pediatric Intensive Care Unit, CHU Sainte Justine, Montréal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
| | - Etienne Javouhey
- Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - David Brossier
- Pediatric Intensive Care Unit, CHU de Caen, Caen, France
- Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
- School of Medicine, University Caen Normandie, Caen, F-14000, France
| |
Collapse
|
40
|
Biomarkers of Brain Injury: A Window on Mechanisms of Injury and Recovery in the Brain. Brain Sci 2022; 12:brainsci12030362. [PMID: 35326318 PMCID: PMC8946249 DOI: 10.3390/brainsci12030362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/06/2022] [Indexed: 01/09/2023] Open
Abstract
The decision-making process regarding management after severe acute brain injury is based on clinical evaluation and depends on the injury etiology as well as radiological and neurophysiological data [...]
Collapse
|
41
|
Ammar R, Chelly H, Kolsi F, Smaoui M, Hamida CB, Bahloul M, Boudawara Z, Bouaziz M. Decompressive craniectomy after traumatic brain injury: An observational study of 147 patients admitted in a Tunisian ICU. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
42
|
Shen SJ, Chou YC, Hsu SC, Lin YT, Lu CJ, Liu SJ. Fabrication of Ropivacaine/Dexamethasone-Eluting Poly(D, L-lactide-co-glycolide) Microparticles via Electrospraying Technique for Postoperational Pain Control. Polymers (Basel) 2022; 14:702. [PMID: 35215615 PMCID: PMC8878160 DOI: 10.3390/polym14040702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023] Open
Abstract
Microencapsulation plays an important role in biomedical technology owing to its particular and attractive characteristics. In this work, we developed ropivacaine and dexamethasone loaded poly(D, L-lactide-co-glycolide) (PLGA) microparticles via electrospraying technique and investigated the release behavior of electrosprayed microparticles. The particle morphology of sprayed particles was assessed using scanning electron microscopy (SEM). The in vitro drug release kinetics were evaluated employing an elution method, and the in vivo pharmaceutical release as well as its efficacy on pain relief were tested using an animal activity model. The microscopic observation suggested that sprayed microparticles exhibit a size distribution of 5-6 µm. Fourier-transform infrared spectrometry and differential scanning calorimetry demonstrated the successful incorporation of pharmaceuticals in the PLGA particulates. The drugs-loaded particles discharged sustainably high concentrations of ropivacaine and dexamethasone at the target region in vivo for over two weeks, and the drug levels in the blood remained low. By adopting the electrospraying technique, we were able to prepare drug-embedded polymeric microparticles with effectiveness and with a sustainable capability for postoperative pain control.
Collapse
Affiliation(s)
- Shih-Jyun Shen
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (S.-J.S.); (S.-C.H.); (Y.-T.L.); (C.-J.L.)
- Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan;
| | - Shih-Chieh Hsu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (S.-J.S.); (S.-C.H.); (Y.-T.L.); (C.-J.L.)
| | - Yu-Ting Lin
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (S.-J.S.); (S.-C.H.); (Y.-T.L.); (C.-J.L.)
| | - Chia-Jung Lu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (S.-J.S.); (S.-C.H.); (Y.-T.L.); (C.-J.L.)
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (S.-J.S.); (S.-C.H.); (Y.-T.L.); (C.-J.L.)
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan;
| |
Collapse
|
43
|
Freitag P, Bechmann C, Eden L, Meffert R, Walles T. Surgical stabilization of serial rib fractures is advantageous in patients with relevant traumatic brain injury. Eur J Trauma Emerg Surg 2022; 48:3237-3242. [PMID: 35128563 PMCID: PMC9360054 DOI: 10.1007/s00068-022-01886-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Purpose
To evaluate the clinical benefit of surgical stabilization of rib fractures (SSRF) in polytrauma patients with serial rib fractures.
Methods
Retrospective single-center cohort analysis in trauma patients. Serial rib fracture was defined as three consecutive ribs confirmed by chest computer tomography (CT). Study cohort includes 243 patients that were treated conservatively and 34 patients that underwent SSRF. Demographic patient data, trauma mechanism, injury pattern, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) and hospital course were analyzed. Two matched pair analyses stratified for ISS (32 pairs) and GCS (25 pairs) were performed.
Results
The majority of patients was male (74%) and aged 55 ± 20 years. Serial rib fractures were associated with more than 6 broken ribs in average (6.3 ± 3.7). Other thoracic bone injury included sternum (18%), scapula (16%) and clavicula (13%). Visceral injury consisted of pneumothorax (51%), lung contusion (33%) and diaphragmatic rupture (2%). Average ISS was 22 ± 7.3. Overall hospital stay was 15.9 and ICU stay 7.4 days. In hospital, mortality was 13%. SSRF did not improve hospital course or postoperative complications in the complete study cohort. However, patients with a significantly reduced GCS (7.6 ± 5.3 vs 11.22 ± 4.8; p = 0.006) benefitted from SSRF. Matched pair analysis stratified for GCS showed shorter ICU stays (9 vs 15 days; p = 0.005) including shorter respirator time (143 vs 305 h; p = 0.003).
Conclusion
Patients with serial rib fractures and simultaneous moderate or severe traumatic brain injury benefit from surgical stabilization of rib fractures.
Collapse
Affiliation(s)
- Philipp Freitag
- Department of Cardiothoracic Surgery, Würzburg University Hospital, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
- Department of Thoracic Surgery, Magdeburg University Medicine, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Cornelius Bechmann
- Department of Cardiothoracic Surgery, Würzburg University Hospital, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Lars Eden
- Department of Trauma, Shoulder and Reconstructive Surgery, Rummelsberg Hospital, Rummelsberg 71, 90592, Schwarzenbruck, Germany
| | - Rainer Meffert
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, Würzburg University Hospital, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Thorsten Walles
- Department of Thoracic Surgery, Magdeburg University Medicine, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| |
Collapse
|
44
|
Perrigault PF, Greco F. Ethical issues in neurocritical care. Rev Neurol (Paris) 2022; 178:57-63. [PMID: 34998525 DOI: 10.1016/j.neurol.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
Medicine has always tried to push the limits of life. The technological and scientific progress made in resuscitation now makes it possible to keep patients who are more and more severely affected alive, by compensating for organ failure. The management of the brain-damaged patient poses specific ethical problems in intensive care. Most in-hospital deaths of patients with severe acute brain injury occur after a decision to withhold or withdraw life-sustaining treatments. In these patients, a problem is the difficulty in predicting outcome at an early stage. Our reasoning in the management of brain-damaged patients in the intensive care is based on the four main principles of medical ethics: autonomy, beneficence, non-maleficence and distributive justice. In the case of a patient suffering from cerebral palsy, consent is most often impossible to obtain. The respect of this autonomy, can be done by means of advance directives or testimonies of the support person and family. Non-malficence in the resuscitated brain-damaged patient consists of avoiding unreasonable obstinacy. Medical futility means that the proposed therapy should not be performed because available data show that it will not improve the patient's medical condition. A determination of medical futility can be made either in the presence of a vanishingly small probability of physiological effect or an exceedingly poor quality of outcome. However, a distinction must be made between loss of autonomy and unreasonable obstinacy. French law specifies that the physician must use collegial procedure in situations that may concern a brain-damaged patient. In terms of ethical decision-making, the concept of "window of opportunity" is often mentioned. The temporal approach taken is the guarantee of an absence of "a rush". It is important for the health care team and the family to share the progress of the treatment so that everyone understands the evolution of what is happening and the risks taken for the patient. The resuscitation of the brain-damaged patient poses specific and difficult ethical problems. One of the challenges is to be able to assume our decisions, understand them and defend them. It is also to maintain the coherence of our actions and the cohesion of our teams necessary for the good care of our patients.
Collapse
Affiliation(s)
- P F Perrigault
- Department of Anesthesiology and Intensive Care Medicine, Gui de Chauliac University Hospital, Montpellier University, School of Medicine, avenue Augustin-Fliche, 34295 Montpellier, France.
| | - F Greco
- Department of Anesthesiology and Intensive Care Medicine, Gui de Chauliac University Hospital, Montpellier University, School of Medicine, avenue Augustin-Fliche, 34295 Montpellier, France
| |
Collapse
|
45
|
Wang Z, Nguonly D, Du RY, Garcia RM, Lam SK. Pediatric traumatic brain injury prehospital guidelines: a systematic review and appraisal. Childs Nerv Syst 2022; 38:51-62. [PMID: 34557952 DOI: 10.1007/s00381-021-05364-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) disproportionately affects children within low- and middle-income countries (LMICs). Prehospital emergency care can mitigate secondary brain injury and improve outcomes. Here, we systematically review clinical practice guidelines (CPGs) for pediatric TBI with the goal to inform LMICs prehospital care. METHODS A systematic search was conducted in PubMed/Medline, Embase, and Web of Science databases. We appraised evidence-based CPGs addressing prehospital management of pediatric TBI using the Appraisal of Guidelines for Research & Evaluation (AGREE) tool. CPGs were rated as high-quality if ≥ 5 (out of 6) AGREE domains scored > 60%. RESULTS Of the 326 articles identified, 10 CPGs were included in analysis. All 10 were developed in HICs, and 4 were rated as high-quality. A total of 154 pediatric prehospital recommendations were grouped into three subcategories, initial assessment (35.7%), prehospital treatment (38.3%), and triage (26.0%). Of these, 79 (51.3%) were evidence-based with grading, and 31 (20.1%) were consensus-based without direct evidence. CONCLUSION Currently available CPGs for prehospital pediatric TBI management were all developed in HICs. Four CPGs have high-quality, and recommendations from these can serve as frameworks for LMICs or resource-limited settings. Context-specific evaluation and implementation of evidence-based recommendations allow LMIC settings to respond to the public health crisis of pediatric TBI and address gaps in trauma care systems.
Collapse
Affiliation(s)
- Zhe Wang
- Department of Neurological Surgery, Stony Brook University Renaissance School of Medicine, Health Science Center T12, Room 080, 100 Nicolls Rd, Stony Brook, NY, 11790, USA.
| | - Dellvin Nguonly
- Department of Emergency Medicine, Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA
| | - Rebecca Y Du
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roxanna M Garcia
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sandi K Lam
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| |
Collapse
|
46
|
Picetti E, Rosenstein I, Balogh ZJ, Catena F, Taccone FS, Fornaciari A, Votta D, Badenes R, Bilotta F. Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review. J Clin Med 2021; 11:18. [PMID: 35011760 PMCID: PMC8745292 DOI: 10.3390/jcm11010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 01/28/2023] Open
Abstract
Managing the acute phase after a severe traumatic brain injury (TBI) with polytrauma represents a challenging situation for every trauma team member. A worldwide variability in the management of these complex patients has been reported in recent studies. Moreover, limited evidence regarding this topic is available, mainly due to the lack of well-designed studies. Anesthesiologists, as trauma team members, should be familiar with all the issues related to the management of these patients. In this narrative review, we summarize the available evidence in this setting, focusing on perioperative brain protection, cardiorespiratory optimization, and preservation of the coagulative function. An overview on simultaneous multisystem surgery (SMS) is also presented.
Collapse
Affiliation(s)
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, 43100 Parma, Italy; (E.P.); (A.F.)
| | - Israel Rosenstein
- Department of Anesthesiology and Critical Care, Policlinico Umberto I Hospital, La Sapienza University of Rome, 00161 Rome, Italy; (I.R.); (D.V.); (F.B.)
| | - Zsolt J. Balogh
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle 2305, Australia;
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital, 47521 Cesena, Italy;
| | - Fabio S. Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium;
| | - Anna Fornaciari
- Department of Anesthesia and Intensive Care, Parma University Hospital, 43100 Parma, Italy; (E.P.); (A.F.)
| | - Danilo Votta
- Department of Anesthesiology and Critical Care, Policlinico Umberto I Hospital, La Sapienza University of Rome, 00161 Rome, Italy; (I.R.); (D.V.); (F.B.)
| | - Rafael Badenes
- Department of Anesthesiology and Intensive Care, Hospital Clìnico Universitario de Valencia, University of Valencia, 46010 Valencia, Spain
| | - Federico Bilotta
- Department of Anesthesiology and Critical Care, Policlinico Umberto I Hospital, La Sapienza University of Rome, 00161 Rome, Italy; (I.R.); (D.V.); (F.B.)
| |
Collapse
|
47
|
Epstein D, Rakedzon S, Kaplan B, Ben Lulu H, Chen J, Samuel N, Lipsky AM, Miller A, Bahouth H, Raz A. Prevalence of significant traumatic brain injury among patients intubated in the field due to impaired level of consciousness. Am J Emerg Med 2021; 52:159-165. [PMID: 34922237 DOI: 10.1016/j.ajem.2021.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/10/2021] [Accepted: 12/08/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Current guidelines advocate prehospital endotracheal intubation (ETI) in patients with suspected severe head injury and impaired level of consciousness. However, the ability to identify patients with traumatic brain injury (TBI) in the prehospital setting is limited and prehospital ETI carries a high complication rate. We investigated the prevalence of significant TBI among patients intubated in the field for that reason. METHODS Data were retrospectively collected from emergency medical services and hospital records of trauma patients for whom prehospital ETI was attempted and who were transferred to Rambam Health Care Campus, Israel. The indication for ETI was extracted. The primary outcome was significant TBI (clinical or radiographic) among patients intubated due to suspected severe head trauma. RESULTS In 57.3% (379/662) of the trauma patients, ETI was attempted due to impaired consciousness. 349 patients were included in the final analysis: 82.8% were male, the median age was 34 years (IQR 23.0-57.3), and 95.7% suffered blunt trauma. 253 patients (72.5%) had significant TBI. In a multivariable analysis, Glasgow Coma Scale>8 and alcohol intoxication were associated with a lower risk of TBI with OR of 0.26 (95% CI 0.13-0.51, p < 0.001) and 0.16 (95% CI 0.06-0.46, p < 0.001), respectively. CONCLUSION Altered mental status in the setting of trauma is a major reason for prehospital ETI. Although most of these patients had TBI, one in four of them did not suffer a significant TBI. Patients with a higher field GCS and those suffering from intoxication have a higher risk of misdiagnosis. Future studies should explore better tools for prehospital assessment of TBI and ways to better define and characterize patients who may benefit from early ETI.
Collapse
Affiliation(s)
- Danny Epstein
- Critical Care Division, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa 3109601, Israel.
| | - Stav Rakedzon
- Department of Internal Medicine B, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa 3109601, Israel
| | - Ben Kaplan
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Efron St 1, Haifa 3109601, Israel
| | - Hen Ben Lulu
- Trauma and Emergency Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa 3109601, Israel
| | - Jacob Chen
- Hospital Management, Meir Medical Center, Tchernichovsky St 59, Kefar Saba 4428164, Israel; Sackler Faculty of Medicine, Tel Aviv University, Klachkin St 35, Tel Aviv 6997801, Israel
| | - Nir Samuel
- Pediatric Emergency Department, Schneider Children's Medical Center, Kaplan St 14, Petah Tikva 4920235, Israel
| | - Ari M Lipsky
- Emergency Department, Emek Medical Center, Yitshak Rabin Boulevard 21, Afula 1834111, Israel
| | - Asaf Miller
- Medical Intensive Care Unit, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa 3109601, Israel
| | - Hany Bahouth
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Efron St 1, Haifa 3109601, Israel; Trauma and Emergency Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa 3109601, Israel
| | - Aeyal Raz
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Efron St 1, Haifa 3109601, Israel; Department of Anesthesiology, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa 3109601, Israel
| |
Collapse
|
48
|
Yuan M, Wu H. Astrocytes in the Traumatic Brain Injury: the Good and the Bad. Exp Neurol 2021; 348:113943. [PMID: 34863998 DOI: 10.1016/j.expneurol.2021.113943] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/08/2021] [Accepted: 11/29/2021] [Indexed: 12/21/2022]
Abstract
Astrocytes control many processes of the nervous system in health and disease, and respond to injury quickly. Astrocytes produce neuroprotective factors in the injured brain to clear cellular debris and to orchestrate neurorestorative processes that are beneficial for neurological recovery after traumatic brain injury (TBI). However, astrocytes also become dysregulated and produce cytotoxic mediators that hinder CNS repair by induction of neuronal dysfunction and cell death. Hence, we discuss the potential role of astrocytes in neuropathological processes such as neuroinflammation, neurogenesis, synaptogenesis and blood-brain barrier repair after TBI. Thus, an improved understanding of the dual role of astrocytes may advance our knowledge of post-brain injury recovery, and provide opportunities for the development of novel therapeutic strategies for TBI.
Collapse
Affiliation(s)
- Mengqi Yuan
- Institute of Neuroscience, Hengyang Medical College, University of South China, Hengyang, 421001, Hunan, China
| | - Haitao Wu
- Beijing Institute of Basic Medical Sciences, 100850 Beijing, China; Key Laboratory of Neuroregeneration, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226019, Jiangsu, China; Chinese Institute for Brain Research (CIBR), 102206 Beijing, China.
| |
Collapse
|
49
|
Greve M. Acute Cycling Injuries. Phys Med Rehabil Clin N Am 2021; 33:135-158. [PMID: 34798995 DOI: 10.1016/j.pmr.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The overall activity of cycling, although profoundly heterogenous, often occurs with mechanisms consistent with motor vehicle collisions. Advanced trauma life support is the standard of care. Traumatic brain injury is the leading cause of death, and concussions are common in cyclists. Road rash is the most common injury, and management should be synonymous with other kinds of burns. A unique aspect of cycling medicine is that it often is done on public roadways in close proximity to the athletes during competition. Clinicians who care for cyclists in the field setting should be prepared to manage a broad spectrum of traumatic injuries.
Collapse
Affiliation(s)
- Mark Greve
- Department of Emergency Medicine, Division of Sports Medicine, Warren Alpert School of Medicine, Brown University, 55 Claverick Street, 2nd floor, Providence, RI 02903, USA.
| |
Collapse
|
50
|
Ortuño Andériz F, Rascón Ramírez FJ, Fuentes Ferrer ME, Pardo Rey C, Bringas Bollada M, Postigo Hernández C, García González I, Álvarez González M, Blesa Malpica A. Decompressive craniectomy in traumatic brain injury: The intensivist's point of view. NEUROCIRUGÍA (ENGLISH EDITION) 2021; 32:278-284. [PMID: 34743825 DOI: 10.1016/j.neucie.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/01/2020] [Indexed: 11/26/2022]
Abstract
OBJETIVE To perform a score with early clinical and radiological findings after a TBI that identifies the patients who in their subsequent evolution are going to undergo DC. METHOD Observational study of a retrospective cohort of patients who, after a TBI, enter the Neurocritical Section of the Intensive Care Unit of our hospital for a period of 5 years (2014-2018). Detection of clinical and radiological criteria and generation of all possible models with significant, clinically relevant and easy to detect early variables. Selection of the one with the lowest Bayesian Information Criterion and Akaike Information Criterion values for the creation of the score. Calibration and internal validation of the score using the Hosmer-Lemeshow and a bootstrapping analysis with 1000 re-samples respectively. RESULTS 37 DC were performed in 153 patients who were admitted after a TBI. The resulting final model included Cerebral Midline Deviation, GCS and Ventricular Collapse with an Area under ROC Curve: 0.84 (95% IC 0.78-0.91) and Hosmer-Lemeshow p=0.71. The developed score detected well those patients who were going to need an early DC (first 24h) after a TBI (2.5±0.5) but not those who would need it in a later stage of their disease (1.7±0.8). However, it seems to advice us about the patients who, although not requiring an early DC are likely to need it later in their evolution (DC after 24h vs. do not require DC, 1.7±0.8 vs. 1±0.7; p=0.002). CONCLUSION We have developed a prognostic score using early clinical-radiological criteria that, in our environment, detects with good sensitivity and specificity those patients who, after a TBI, will require a DC.
Collapse
Affiliation(s)
- Francisco Ortuño Andériz
- Servicio de Medicina Intensiva, Sección de Neurocríticos, Hospital Clínico Universitario San Carlos, Madrid, Spain.
| | | | | | - Cándido Pardo Rey
- Servicio de Medicina Intensiva, Sección de Neurocríticos, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - María Bringas Bollada
- Servicio de Medicina Intensiva, Sección de Neurocríticos, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Carolina Postigo Hernández
- Servicio de Medicina Intensiva, Sección de Neurocríticos, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Inés García González
- Servicio de Medicina Intensiva, Sección de Neurocríticos, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Manuel Álvarez González
- Servicio de Medicina Intensiva, Sección de Neurocríticos, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Antonio Blesa Malpica
- Servicio de Medicina Intensiva, Sección de Neurocríticos, Hospital Clínico Universitario San Carlos, Madrid, Spain
| |
Collapse
|