1
|
Wang X, Chen S, Wang X, Song Z, Wang Z, Niu X, Chen X, Chen X. Application of artificial hibernation technology in acute brain injury. Neural Regen Res 2024; 19:1940-1946. [PMID: 38227519 DOI: 10.4103/1673-5374.390968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/20/2023] [Indexed: 01/17/2024] Open
Abstract
Controlling intracranial pressure, nerve cell regeneration, and microenvironment regulation are the key issues in reducing mortality and disability in acute brain injury. There is currently a lack of effective treatment methods. Hibernation has the characteristics of low temperature, low metabolism, and hibernation rhythm, as well as protective effects on the nervous, cardiovascular, and motor systems. Artificial hibernation technology is a new technology that can effectively treat acute brain injury by altering the body's metabolism, lowering the body's core temperature, and allowing the body to enter a state similar to hibernation. This review introduces artificial hibernation technology, including mild hypothermia treatment technology, central nervous system regulation technology, and artificial hibernation-inducer technology. Upon summarizing the relevant research on artificial hibernation technology in acute brain injury, the research results show that artificial hibernation technology has neuroprotective, anti-inflammatory, and oxidative stress-resistance effects, indicating that it has therapeutic significance in acute brain injury. Furthermore, artificial hibernation technology can alleviate the damage of ischemic stroke, traumatic brain injury, cerebral hemorrhage, cerebral infarction, and other diseases, providing new strategies for treating acute brain injury. However, artificial hibernation technology is currently in its infancy and has some complications, such as electrolyte imbalance and coagulation disorders, which limit its use. Further research is needed for its clinical application.
Collapse
Affiliation(s)
- Xiaoni Wang
- Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shulian Chen
- Characteristic Medical Center of People's Armed Police Forces, Tianjin, China
| | - Xiaoyu Wang
- Characteristic Medical Center of People's Armed Police Forces, Tianjin, China
| | - Zhen Song
- Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ziqi Wang
- Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaofei Niu
- Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaochu Chen
- Characteristic Medical Center of People's Armed Police Forces, Tianjin, China
| | - Xuyi Chen
- Characteristic Medical Center of People's Armed Police Forces, Tianjin, China
| |
Collapse
|
2
|
Brasil S, Godoy DA, Videtta W, Rubiano AM, Solla D, Taccone FS, Robba C, Rasulo F, Aries M, Smielewski P, Meyfroidt G, Battaglini D, Hirzallah MI, Amorim R, Sampaio G, Moulin F, Deana C, Picetti E, Kolias A, Hutchinson P, Hawryluk GW, Czosnyka M, Panerai RB, Shutter LA, Park S, Rynkowski C, Paranhos J, Silva THS, Malbouisson LMS, Paiva WS. A Comprehensive Perspective on Intracranial Pressure Monitoring and Individualized Management in Neurocritical Care: Results of a Survey with Global Experts. Neurocrit Care 2024:10.1007/s12028-024-02008-z. [PMID: 38811514 DOI: 10.1007/s12028-024-02008-z] [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: 02/23/2024] [Accepted: 05/01/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Numerous trials have addressed intracranial pressure (ICP) management in neurocritical care. However, identifying its harmful thresholds and controlling ICP remain challenging in terms of improving outcomes. Evidence suggests that an individualized approach is necessary for establishing tolerance limits for ICP, incorporating factors such as ICP waveform (ICPW) or pulse morphology along with additional data provided by other invasive (e.g., brain oximetry) and noninvasive monitoring (NIM) methods (e.g., transcranial Doppler, optic nerve sheath diameter ultrasound, and pupillometry). This study aims to assess current ICP monitoring practices among experienced clinicians and explore whether guidelines should incorporate ancillary parameters from NIM and ICPW in future updates. METHODS We conducted a survey among experienced professionals involved in researching and managing patients with severe injury across low-middle-income countries (LMICs) and high-income countries (HICs). We sought their insights on ICP monitoring, particularly focusing on the impact of NIM and ICPW in various clinical scenarios. RESULTS From October to December 2023, 109 professionals from the Americas and Europe participated in the survey, evenly distributed between LMIC and HIC. When ICP ranged from 22 to 25 mm Hg, 62.3% of respondents were open to considering additional information, such as ICPW and other monitoring techniques, before adjusting therapy intensity levels. Moreover, 77% of respondents were inclined to reassess patients with ICP in the 18-22 mm Hg range, potentially escalating therapy intensity levels with the support of ICPW and NIM. Differences emerged between LMIC and HIC participants, with more LMIC respondents preferring arterial blood pressure transducer leveling at the heart and endorsing the use of NIM techniques and ICPW as ancillary information. CONCLUSIONS Experienced clinicians tend to personalize ICP management, emphasizing the importance of considering various monitoring techniques. ICPW and noninvasive techniques, particularly in LMIC settings, warrant further exploration and could potentially enhance individualized patient care. The study suggests updating guidelines to include these additional components for a more personalized approach to ICP management.
Collapse
Affiliation(s)
- Sérgio Brasil
- Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil.
| | | | - Walter Videtta
- Intensive Care Unit, Hospital Posadas, Buenos Aires, Argentina
| | | | - Davi Solla
- Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Chiara Robba
- Anesthesia and Intensive Care, Scientific Institute for Research, Hospitalization and Healthcare, Policlínico San Martino, Genoa, Italy
| | - Frank Rasulo
- Neuroanesthesia, Neurocritical and Postoperative Care, Spedali Civili University Affiliated Hospital of Brescia, Brescia, Italy
| | - Marcel Aries
- Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Mental Health and Neurosciences, University Maastricht, Maastricht, The Netherlands
| | - Peter Smielewski
- Department of Clinical Neurosciences, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Denise Battaglini
- Anesthesia and Intensive Care, Scientific Institute for Research, Hospitalization and Healthcare, Policlínico San Martino, Genoa, Italy
| | - Mohammad I Hirzallah
- Departments of Neurology, Neurosurgery, and Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Robson Amorim
- Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Gisele Sampaio
- Neurology Department, São Paulo Federal University Medical School, São Paulo, Brazil
| | - Fabiano Moulin
- Neurology Department, São Paulo Federal University Medical School, São Paulo, Brazil
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | | | | | - Gregory W Hawryluk
- Cleveland Clinic Neurological Institute, Akron General Hospital, Fairlawn, OH, USA
- Uniformed Services University, Bethesda, USA
- Brain Trauma Foundation, New York, USA
| | - Marek Czosnyka
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Ronney B Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Lori A Shutter
- Departments of Critical Care Medicine, Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Soojin Park
- Departments of Neurology and Biomedical Informatics, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY, USA
| | - Carla Rynkowski
- Department of Urgency and Trauma, Medical Faculty, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Jorge Paranhos
- Intensive Care and Neuroemergency, Santa Casa de Misericórdia, São João del Rei, Brazil
| | - Thiago H S Silva
- Department of Intensive Care, School of Medicine University of São Paulo, São Paulo, Brazil
| | - Luiz M S Malbouisson
- Department of Intensive Care, School of Medicine University of São Paulo, São Paulo, Brazil
| | - Wellingson S Paiva
- Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| |
Collapse
|
3
|
Fang Y, Zhang Y, Huang X, Liu Q, Li Y, Jia C, He L, Ren C, Zhang X. Association Between Temperature During Intensive Care Unit and Mortality in Patients With Acute Respiratory Distress Syndrome. Ther Hypothermia Temp Manag 2023. [PMID: 37976202 DOI: 10.1089/ther.2023.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
The relationship between body temperature changes and prognosis in patients with acute respiratory distress syndrome (ARDS) remains inconclusive. Our study aimed to investigate the clinical value of body temperature in the management of ARDS. Data from the Medical Information Mart for Intensive Care III database were collected. Adult patients with ARDS were enrolled and further grouped based on their temperature values in the intensive care unit. Both the maximum (temperaturemax) and minimum (temperaturemin) temperatures were used. The primary outcome was 28-day mortality rate. Polynomial regression, subgroup analysis, and logistic regression analysis were performed in the final analysis. A total of 3922 patients with ARDS were enrolled. There was a U-shaped relationship between 28-day mortality and body temperature. For patients with infection, the elevated temperaturemax (≥37.0°C) was associated with decreased mortality, with an odds ratio ranging from 0.39 to 0.49, using temperaturemax from 36.5°C to 36.9°C as reference. For patients without infection, a similar tendency was observed, but the protective effect was lost at extremely high temperatures (≥38.0°C, p < 0.05). Elevated temperaturemin (≥37.0°C) and decreased temperaturemin (<35.0°C) were associated with increased mortality, using the temperaturemin from 36.0°C to 36.9°C as a reference. Hypothermia was associated with increased mortality in patients with ARDS, while the effect of hyperthermia (≥37.0°C) on the mortality of patients with ARDS was not fully consistent in the infection and noninfection subgroups. Short-term and transient temperatures above 37.0°C would be beneficial to patients with ARDS, but extreme hyperthermia and persistent temperatures above 37.0°C should be avoided.
Collapse
Affiliation(s)
- Yipeng Fang
- Laboratory of Molecular Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | | | - Xianxi Huang
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Qian Liu
- Shantou University Medical College, Shantou, Guangdong, China
- Department of Cardiology, The Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, China
| | - Yueyang Li
- Shantou University Medical College, Shantou, Guangdong, China
| | - Chenxi Jia
- Shantou University Medical College, Shantou, Guangdong, China
| | - Lingbin He
- Shantou University Medical College, Shantou, Guangdong, China
| | - Chunhong Ren
- International Medical Service Center, The First Affiliated hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xin Zhang
- Laboratory of Molecular Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| |
Collapse
|
4
|
Escamilla-Ocañas CE, Albores-Ibarra N. Current status and outlook for the management of intracranial hypertension after traumatic brain injury: decompressive craniectomy, therapeutic hypothermia, and barbiturates. Neurologia 2023:S2173-5808(23)00008-1. [PMID: 37031799 DOI: 10.1016/j.nrleng.2020.08.024] [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: 02/17/2020] [Accepted: 08/04/2020] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION Increased intracranial pressure (ICP) has been associated with poor neurological outcomes and increased mortality in patients with severe traumatic brain injury (TBI). Traditionally, ICP-lowering therapies are administered using an escalating approach, with more aggressive options reserved for patients showing no response to first-tier interventions, or with refractory intracranial hypertension. DEVELOPMENT The therapeutic value and the appropriate timing for the use of rescue treatments for intracranial hypertension have been a subject of constant debate in literature. In this review, we discuss the main management options for refractory intracranial hypertension after severe TBI in adults. We intend to conduct an in-depth revision of the most representative randomised controlled trials on the different rescue treatments, including decompressive craniectomy, therapeutic hypothermia, and barbiturates. We also discuss future perspectives for these management options. CONCLUSIONS The available evidence appears to show that mortality can be reduced when rescue interventions are used as last-tier therapy; however, this benefit comes at the cost of severe disability. The decision of whether to perform these interventions should always be patient-centred and made on an individual basis. The development and integration of different physiological variables through multimodality monitoring is of the utmost importance to provide more robust prognostic information to patients facing these challenging decisions.
Collapse
Affiliation(s)
- César E Escamilla-Ocañas
- Department of Neurology, Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA.
| | - Nadxielli Albores-Ibarra
- División de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
| |
Collapse
|
5
|
Effect of Hypothermia Therapy on Children with Traumatic Brain Injury: A Meta-Analysis of Randomized Controlled Trials. Brain Sci 2022; 12:brainsci12081009. [PMID: 36009072 PMCID: PMC9406098 DOI: 10.3390/brainsci12081009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Hypothermia therapy is a promising therapeutic strategy for traumatic brain injury (TBI); however, some trials have shown that hypothermia therapy has a negative effect on patients with TBI. The treatment of hypothermia in children with TBI remains controversial. We conducted a search of six online databases to validate the literature on comparing hypothermia with normal therapy for children with TBI. Eight randomized controlled trials (514 patients) were included. The meta-analysis indicated that hypothermia therapy may increase the Glasgow Outcome Scale (GOS) scores. However, in terms of improving the rate of complications, intracranial pressure (ICP), mortality, cerebral perfusion pressure (CPP), and length of stay both in hospital as well as pediatric ICU, the difference was not statistically significant. Hypothermia therapy may have clinical advantages in improving the GOS scores in children with TBI compared with normothermic therapy, but hypothermia therapy may have no benefit in improving the incidence of complications, ICP, mortality, CPP, and length of stay both in pediatric ICU as well as hospital. The decision to implement hypothermia therapy for children with TBI depends on the advantages and disadvantages from many aspects and these must be considered comprehensively.
Collapse
|
6
|
Shao S, Guo T, Li F, Zhao Z, Li J, Wang X. Experimental study on the therapeutic effect of BDNF gene-carrying nanoparticles on traumatic brain injury. APPLIED NANOSCIENCE 2022. [DOI: 10.1007/s13204-022-02405-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
7
|
Wang W, Du T, Jiang X. Correlation between 25-Hydroxyvitamin D, sFlt-1, PLGF, and Hypertension in Pregnancy. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9371953. [PMID: 34760146 PMCID: PMC8575607 DOI: 10.1155/2021/9371953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 01/31/2023]
Abstract
Gestational hypertension is a common disease in clinical practice, which does great harm to the mother and infant. The purpose of this study was to investigate the relationship between 25-hydroxyvitamin D, sFlt-1, and PLGF and hypertensive disorder complicating pregnancy. Specimen preparation: after delivery or placental caesarean section, in order to avoid calcification and necrosis in the middle of the placenta, an area of about 1.5 cm × 1.5 cm × 1.5 cm should be separated immediately. After dehydration, use a Citadel 2000 dryer to dry it and place it in a block of saline for xylene immunohistochemical staining. Statistical processing was performed according to the proportion of positive cells in each part and the depth of staining. Placental tissue collection and treatment: within 20 minutes after the delivery of the placenta, two pieces of the placental tissue (about 1.0 cm × 1.0 cm × 1.0 cm) were taken from the central zone of the placental maternal surface without obvious bleeding and calcification. They were rinsed repeatedly in normal saline, fixed in 10% neutral formaldehyde solution for 24 hours, dehydrated using an automatic dehydrator, and embedded in paraffin for detection. Before the study, 20 ml of distilled water was added to the sample to stand for 20 minutes; the Cobas E610 immunoanalyzer was turned on, and sFlt-1 and PLGF (placental growth factor) were selected. The serum 25-hydroxyvitamin D level of pregnant women was detected in the fasting state at 24-28 weeks of gestation, and the best collection time was 8 : 00-11 : 00 in the morning. 5 ml of the whole blood sample without anticoagulant was collected and stored at 0-4°C in a cold storage and dark environment. The serum was obtained by high-speed centrifugation within 24 hours after collection. The method is suitable for the quantitative determination of 25-OH-vitamin D in human serum. In the hypertensive pregnancy group, the level of 25-hydroxyvitamin D was 18.44 ± 3.48 ng/ml, and the sFlt-1/PLGF level was highest at 0-5 weeks followed by 5-10 weeks, 10-15 weeks, and 15-20 weeks. This study provides new ideas and experimental clues for the prevention and treatment of pre-eclampsia.
Collapse
Affiliation(s)
- Wei Wang
- Obstetrics Department, Weifang Maternal and Child Health Hospital, Weifang 261000, Shandong, China
| | - Ting Du
- Obstetrics Department, Weifang Maternal and Child Health Hospital, Weifang 261000, Shandong, China
| | - Xiaoqi Jiang
- Obstetrics Department, Weifang Maternal and Child Health Hospital, Weifang 261000, Shandong, China
| |
Collapse
|
8
|
Lachance BB, Chang W, Motta M, Parikh G, Podell J, Badjatia N, Simard JM, Schwartzbauer GT, Morris NA. Verticalization for Refractory Intracranial Hypertension: A Case Series. Neurocrit Care 2021; 36:463-470. [PMID: 34405321 DOI: 10.1007/s12028-021-01323-z] [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: 05/19/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe intracranial hypertension is strongly associated with mortality. Guidelines recommend medical management involving sedation, hyperosmotic agents, barbiturates, hypothermia, and surgical intervention. When these interventions are maximized or are contraindicated, refractory intracranial hypertension poses risk for herniation and death. We describe a novel intervention of verticalization for treating intracranial hypertension refractory to aggressive medical treatment. METHODS This study was a single-center retrospective review of six cases of refractory intracranial hypertension in a tertiary care center. All patients were treated with a standard-of-care algorithm for lowering intracranial pressure (ICP) yet maintained an ICP greater than 20 mmHg. They were then treated with verticalization for at least 24 h. We compared the median ICP, the number of ICP spikes greater than 20 mmHg, and the percentage of ICP values greater than 20 mmHg in the 24 h before verticalization vs. after verticalization. We assessed the use of hyperosmotic therapies and any changes in the mean arterial pressure and cerebral perfusion pressure related with the intervention. RESULTS Five patients were admitted with subarachnoid hemorrhage and one with intracerebral hemorrhage. All patients had ICP monitoring by external ventricular drain. The median opening pressure was 30 mmHg (25th-75th interquartile range 22.5-30 mmHg). All patients demonstrated a reduction in ICP after verticalization, with a significant decrease in the median ICP (12 vs. 8 mmHg; p < 0.001), the number of ICP spikes (12 vs. 2; p < 0.01), and the percentage of ICP values greater than 20 mmHg (50% vs. 8.3%; p < 0.01). There was a decrease in total medical interventions after verticalization (79 vs. 41; p = 0.05) and a lower total therapy intensity level score after verticalization. The most common adverse effects included asymptomatic bradycardia (n = 3) and pressure wounds (n = 4). CONCLUSIONS Verticalization is an effective noninvasive intervention for lowering ICP in intracranial hypertension that is refractory to aggressive standard management and warrants further study.
Collapse
Affiliation(s)
- Brittany Bolduc Lachance
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - WanTsu Chang
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Melissa Motta
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Gunjan Parikh
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jamie Podell
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Neeraj Badjatia
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - J Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Gary T Schwartzbauer
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Nicholas A Morris
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| |
Collapse
|
9
|
Age- and Severity-Related In-Hospital Mortality Trends and Risks of Severe Traumatic Brain Injury in Japan: A Nationwide 10-Year Retrospective Study. J Clin Med 2021; 10:jcm10051072. [PMID: 33806639 PMCID: PMC7961410 DOI: 10.3390/jcm10051072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 01/08/2023] Open
Abstract
Traumatic brain injury (TBI) is the major cause of mortality and morbidity in severely-injured patients worldwide. This retrospective nationwide study aimed to evaluate the age- and severity-related in-hospital mortality trends and mortality risks of patients with severe TBI from 2009 to 2018 to establish effective injury prevention measures. We retrieved information from the Japan Trauma Data Bank dataset between 2009 and 2018. The inclusion criteria for this study were patients with severe TBI defined as those with an Injury Severity Score ≥ 16 and TBI. In total, 31,953 patients with severe TBI (32.6%) were included. There were significant age-related differences in characteristics, mortality trend, and mortality risk in patients with severe TBI. The in-hospital mortality trend of all patients with severe TBI significantly decreased but did not improve for patients aged ≤ 5 years and with a Glasgow Coma Scale (GCS) score between 3 and 8. Severe TBI, age ≥ 65 years, fall from height, GCS score 3-8, and urgent blood transfusion need were associated with a higher mortality risk, and mortality risk did not decrease after 2013. Physicians should consider specific strategies when treating patients with any of these risk factors to reduce severe TBI mortality.
Collapse
|
10
|
Escamilla-Ocañas CE, Albores-Ibarra N. Current status and outlook for the management of intracranial hypertension after traumatic brain injury: decompressive craniectomy, therapeutic hypothermia, and barbiturates. Neurologia 2020; 38:S0213-4853(20)30274-7. [PMID: 33069447 DOI: 10.1016/j.nrl.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/20/2020] [Accepted: 08/04/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Increased intracranial pressure has been associated with poor neurological outcomes and increased mortality in patients with severe traumatic brain injury. Traditionally, intracranial pressure-lowering therapies are administered using an escalating approach, with more aggressive options reserved for patients showing no response to first-tier interventions, or with refractory intracranial hypertension. DEVELOPMENT The therapeutic value and the appropriate timing for the use of rescue treatments for intracranial hypertension have been a subject of constant debate in literature. In this review, we discuss the main management options for refractory intracranial hypertension after severe traumatic brain injury in adults. We intend to conduct an in-depth revision of the most representative randomised controlled trials on the different rescue treatments, including decompressive craniectomy, therapeutic hypothermia, and barbiturates. We also discuss future perspectives for these management options. CONCLUSIONS The available evidence appears to show that mortality can be reduced when rescue interventions are used as last-tier therapy; however, this benefit comes at the cost of severe disability. The decision of whether to perform these interventions should always be patient-centred and made on an individual basis. The development and integration of different physiological variables through multimodality monitoring is of the utmost importance to provide more robust prognostic information to patients facing these challenging decisions.
Collapse
Affiliation(s)
- C E Escamilla-Ocañas
- Department of Neurology, Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, EE. UU..
| | - N Albores-Ibarra
- División de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
| |
Collapse
|
11
|
Chen H, Wu F, Yang P, Shao J, Chen Q, Zheng R. A meta-analysis of the effects of therapeutic hypothermia in adult patients with traumatic brain injury. Crit Care 2019; 23:396. [PMID: 31806001 PMCID: PMC6896404 DOI: 10.1186/s13054-019-2667-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose Therapeutic hypothermia management remains controversial in patients with traumatic brain injury. We conducted a meta-analysis to evaluate the risks and benefits of therapeutic hypothermia management in patients with traumatic brain injury. Methods We searched the Web of Science, PubMed, Embase, Cochrane (Central) and Clinical Trials databases from inception to January 17, 2019. Eligible studies were randomised controlled trials that investigated therapeutic hypothermia management versus normothermia management in patients with traumatic brain injury. We collected the individual data of the patients from each included study. Meta-analyses were performed for 6-month mortality, unfavourable functional outcome and pneumonia morbidity. The risk of bias was evaluated using the Cochrane Risk of Bias tool. Results Twenty-three trials involving a total of 2796 patients were included. The randomised controlled trials with a high quality show significantly more mortality in the therapeutic hypothermia group [risk ratio (RR) 1.26, 95% confidence interval (CI) 1.04 to 1.53, p = 0.02]. Lower mortality in the therapeutic hypothermia group occurred when therapeutic hypothermia was received within 24 h (RR 0.83, 95% CI 0.71 to 0.96, p = 0.01), when hypothermia was received for treatment (RR 0.66, 95% CI 0.49 to 0.88, p = 0.006) or when hypothermia was combined with post-craniectomy measures (RR 0.69, 95% CI 0.48 to 1.00, p = 0.05). The risk of unfavourable functional outcome following therapeutic hypothermia management appeared to be significantly reduced (RR 0.78, 95% CI 0.67 to 0.91, p = 0.001). The meta-analysis suggested that there was a significant increase in the risk of pneumonia with therapeutic hypothermia management (RR 1.48, 95% CI 1.11 to 1.97, p = 0.007). Conclusions Our meta-analysis demonstrated that therapeutic hypothermia did not reduce but might increase the mortality rate of patients with traumatic brain injury in some high-quality studies. However, traumatic brain injury patients with elevated intracranial hypertension could benefit from hypothermia in therapeutic management instead of prophylaxis when initiated within 24 h.
Collapse
Affiliation(s)
- Hanbing Chen
- Graduate School of Dalian Medical University; Department of Critical Care Medicine, Northern Jiangsu People's Hospital; Clinical Medical College, Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Fei Wu
- Department of Intensive Care Unit, Affiliated Hospital of Yangzhou University, Clinical Medical College, Yangzhou University, No.368 Hanjiangzhonglu Road, Yangzhou, 225001, Jiangsu, China
| | - Penglei Yang
- Graduate School of Dalian Medical University; Department of Critical Care Medicine, Northern Jiangsu People's Hospital; Clinical Medical College, Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Jun Shao
- Department of Critical Care Medicine, Northern Jiangsu People's Hospital; Clinical Medical College, Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Qihong Chen
- Department of Critical Care Medicine, Jiangdu People's Hospital of Yangzhou, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, No 9 Dongfanghong Road of Jiangdu District, Yangzhou, 225001, Jiangsu, China.
| | - Ruiqiang Zheng
- Department of Critical Care Medicine, Northern Jiangsu People's Hospital; Clinical Medical College, Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
| |
Collapse
|
12
|
Walsh JJ, Huang Y, Simmons JW, Goodrich JA, McHugh B, Rothman DL, Elefteriades JA, Hyder F, Coman D. Dynamic Thermal Mapping of Localized Therapeutic Hypothermia in the Brain. J Neurotrauma 2019; 37:55-65. [PMID: 31311414 DOI: 10.1089/neu.2019.6485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Although whole body cooling is used widely to provide therapeutic hypothermia for the brain, there are undesirable clinical side effects. Selective brain cooling may allow for rapid and controllable neuroprotection while mitigating these undesirable side effects. We evaluated an innovative cerebrospinal fluid (CSF) cooling platform that utilizes chilled saline pumped through surgically implanted intraventricular catheters to induce hypothermia. Magnetic resonance thermal imaging of the healthy sheep brain (n = 4) at 7.0T provided dynamic temperature measurements from the whole brain. Global brain temperature was 38.5 ± 0.8°C at baseline (body temperature of 39.2 ± 0.4°C), and decreased by 3.1 ± 0.3°C over ∼30 min of cooling (p < 0.0001). Significant cooling was achieved in all defined regions across both the ipsilateral and contralateral hemispheres relative to catheter placement. On cooling cessation, global brain temperature increased by 3.1 ± 0.2°C over ∼20 min (p < 0.0001). Rapid and synchronized temperature fall/rise on cooling onset/offset was observed reproducibly with rates ranging from 0.06-0.21°C/min, where rewarming was faster than cooling (p < 0.0001) signifying the importance of thermoregulation in the brain. Although core regions (including the subcortex, midbrain, olfactory tract, temporal lobe, occipital lobe, and parahippocampal cortex) had slightly warmer (∼0.2°C) baseline temperatures, after cooling, temperatures reached the same level as the non-core regions (35.6 ± 0.2°C), indicating the cooling effectiveness of the CSF-based cooling device. In summary, CSF-based intraventricular cooling reliably reduces temperature in all identified brain regions to levels known to be neuroprotective, while maintaining overall systemic normothermia. Dynamic thermal mapping provides high spatiotemporal temperature measurements that can aid in optimizing selective neuroprotective protocols.
Collapse
Affiliation(s)
- John J Walsh
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Yuegao Huang
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | | | - James A Goodrich
- Department of Comparative Medicine, Yale University, New Haven, Connecticut
| | - Brian McHugh
- Department of Neurosurgery, Yale University, New Haven, Connecticut.,Inova Medical Group Neurosurgery, Fairfax, Virginia
| | - Douglas L Rothman
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut.,Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | | | - Fahmeed Hyder
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut.,Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Daniel Coman
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| |
Collapse
|
13
|
Kurisu K, Kim JY, You J, Yenari MA. Therapeutic Hypothermia and Neuroprotection in Acute Neurological Disease. Curr Med Chem 2019; 26:5430-5455. [PMID: 31057103 PMCID: PMC6913523 DOI: 10.2174/0929867326666190506124836] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/24/2018] [Accepted: 04/11/2019] [Indexed: 01/07/2023]
Abstract
Therapeutic hypothermia has consistently been shown to be a robust neuroprotectant in many labs studying different models of neurological disease. Although this therapy has shown great promise, there are still challenges at the clinical level that limit the ability to apply this routinely to each pathological condition. In order to overcome issues involved in hypothermia therapy, understanding of this attractive therapy is needed. We review methodological concerns surrounding therapeutic hypothermia, introduce the current status of therapeutic cooling in various acute brain insults, and review the literature surrounding the many underlying molecular mechanisms of hypothermic neuroprotection. Because recent work has shown that body temperature can be safely lowered using pharmacological approaches, this method may be an especially attractive option for many clinical applications. Since hypothermia can affect multiple aspects of brain pathophysiology, therapeutic hypothermia could also be considered a neuroprotection model in basic research, which would be used to identify potential therapeutic targets. We discuss how research in this area carries the potential to improve outcome from various acute neurological disorders.
Collapse
Affiliation(s)
- Kota Kurisu
- Department of Neurology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, California 94121, USA
| | - Jong Youl Kim
- Department of Neurology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, California 94121, USA
- Departments of Anatomy, Yonsei University College of Medicine, Seoul, South Korea
| | - Jesung You
- Department of Neurology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, California 94121, USA
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Midori A. Yenari
- Department of Neurology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, California 94121, USA
| |
Collapse
|
14
|
Koenig JB, Dulla CG. Dysregulated Glucose Metabolism as a Therapeutic Target to Reduce Post-traumatic Epilepsy. Front Cell Neurosci 2018; 12:350. [PMID: 30459556 PMCID: PMC6232824 DOI: 10.3389/fncel.2018.00350] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/19/2018] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) is a significant cause of disability worldwide and can lead to post-traumatic epilepsy. Multiple molecular, cellular, and network pathologies occur following injury which may contribute to epileptogenesis. Efforts to identify mechanisms of disease progression and biomarkers which predict clinical outcomes have focused heavily on metabolic changes. Advances in imaging approaches, combined with well-established biochemical methodologies, have revealed a complex landscape of metabolic changes that occur acutely after TBI and then evolve in the days to weeks after. Based on this rich clinical and preclinical data, combined with the success of metabolic therapies like the ketogenic diet in treating epilepsy, interest has grown in determining whether manipulating metabolic activity following TBI may have therapeutic value to prevent post-traumatic epileptogenesis. Here, we focus on changes in glucose utilization and glycolytic activity in the brain following TBI and during seizures. We review relevant literature and outline potential paths forward to utilize glycolytic inhibitors as a disease-modifying therapy for post-traumatic epilepsy.
Collapse
Affiliation(s)
- Jenny B Koenig
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, United States
| | - Chris G Dulla
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, United States
| |
Collapse
|
15
|
Prophylactic and Therapeutic Hypothermia in Severe Traumatic Brain Injury. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Presneill J, Gantner D, Nichol A, McArthur C, Forbes A, Kasza J, Trapani T, Murray L, Bernard S, Cameron P, Capellier G, Huet O, Newby L, Rashford S, Rosenfeld JV, Smith T, Stephenson M, Varma D, Vallance S, Walker T, Webb S, James Cooper D. Statistical analysis plan for the POLAR-RCT: The Prophylactic hypOthermia trial to Lessen trAumatic bRain injury-Randomised Controlled Trial. Trials 2018; 19:259. [PMID: 29703266 PMCID: PMC5923032 DOI: 10.1186/s13063-018-2610-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 03/27/2018] [Indexed: 01/10/2023] Open
Abstract
Background The Prophylactic hypOthermia to Lessen trAumatic bRain injury-Randomised Controlled Trial (POLAR-RCT) will evaluate whether early and sustained prophylactic hypothermia delivered to patients with severe traumatic brain injury improves patient-centred outcomes. Methods The POLAR-RCT is a multicentre, randomised, parallel group, phase III trial of early, prophylactic cooling in critically ill patients with severe traumatic brain injury, conducted in Australia, New Zealand, France, Switzerland, Saudi Arabia and Qatar. A total of 511 patients aged 18–60 years have been enrolled with severe acute traumatic brain injury. The trial intervention of early and sustained prophylactic hypothermia to 33 °C for 72 h will be compared to standard normothermia maintained at a core temperature of 37 °C. The primary outcome is the proportion of favourable neurological outcomes, comprising good recovery or moderate disability, observed at six months following randomisation utilising a midpoint dichotomisation of the Extended Glasgow Outcome Scale (GOSE). Secondary outcomes, also assessed at six months following randomisation, include the probability of an equal or greater GOSE level, mortality, the proportions of patients with haemorrhage or infection, as well as assessment of quality of life and health economic outcomes. The planned sample size will allow 80% power to detect a 30% relative risk increase from 50% to 65% (equivalent to a 15% absolute risk increase) in favourable neurological outcome at a two-sided alpha of 0.05. Discussion Consistent with international guidelines, a detailed and prospective analysis plan has been developed for the POLAR-RCT. This plan specifies the statistical models for evaluation of primary and secondary outcomes, as well as defining covariates for adjusted analyses and methods for exploratory analyses. Application of this statistical analysis plan to the forthcoming POLAR-RCT trial will facilitate unbiased analyses of these important clinical data. Trial registration ClinicalTrials.gov, NCT00987688 (first posted 1 October 2009); Australian New Zealand Clinical Trials Registry, ACTRN12609000764235. Registered on 3 September 2009. Electronic supplementary material The online version of this article (10.1186/s13063-018-2610-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jeffrey Presneill
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Dashiell Gantner
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Department of Intensive Care, The Alfred, Melbourne, Australia
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Department of Intensive Care, The Alfred, Melbourne, Australia.,Department of Anaesthesia and Intensive Care Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College, Dublin, Ireland
| | - Colin McArthur
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Andrew Forbes
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia
| | - Jessica Kasza
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Department of Intensive Care, The Alfred, Melbourne, Australia
| | - Lynnette Murray
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia
| | - Stephen Bernard
- Department of Intensive Care, The Alfred, Melbourne, Australia.,Ambulance Victoria, Melbourne, Australia
| | - Peter Cameron
- Centre of Excellence in Traumatic Brain Injury Research, The Alfred, Monash University, Melbourne, Australia.,Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gilles Capellier
- Réanimation médicale CHRU Jean Minjoz, Besançon, France.,Université de Franche - Comte, 1 Rue Claude Goudimel, Besançon, 25030, France
| | - Olivier Huet
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Department of Anaesthesia and Intensive Care Medicine, Hôpital de La Cavale Blanche, CHRU de Brest, Brest, France.,UFR de médecine et des sciences de la santé, Université de Bretagne Occidental, Brest, France
| | - Lynette Newby
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | | | - Jeffrey V Rosenfeld
- Department of Surgery, Monash University, Melbourne, Australia.,Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences (USUHS), Bethesda, MD, USA
| | - Tony Smith
- St John New Zealand, Auckland, New Zealand.,Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Michael Stephenson
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Ambulance Victoria, Melbourne, Australia
| | - Dinesh Varma
- Department of Radiology, The Alfred Hospital, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - Shirley Vallance
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Department of Intensive Care, The Alfred, Melbourne, Australia
| | | | - Steve Webb
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Intensive Care Unit, Royal Perth Hospital, Perth, Australia
| | - D James Cooper
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia. .,Department of Intensive Care, The Alfred, Melbourne, Australia.
| | | |
Collapse
|
17
|
Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, Bragge P, Brazinova A, Büki A, Chesnut RM, Citerio G, Coburn M, Cooper DJ, Crowder AT, Czeiter E, Czosnyka M, Diaz-Arrastia R, Dreier JP, Duhaime AC, Ercole A, van Essen TA, Feigin VL, Gao G, Giacino J, Gonzalez-Lara LE, Gruen RL, Gupta D, Hartings JA, Hill S, Jiang JY, Ketharanathan N, Kompanje EJO, Lanyon L, Laureys S, Lecky F, Levin H, Lingsma HF, Maegele M, Majdan M, Manley G, Marsteller J, Mascia L, McFadyen C, Mondello S, Newcombe V, Palotie A, Parizel PM, Peul W, Piercy J, Polinder S, Puybasset L, Rasmussen TE, Rossaint R, Smielewski P, Söderberg J, Stanworth SJ, Stein MB, von Steinbüchel N, Stewart W, Steyerberg EW, Stocchetti N, Synnot A, Te Ao B, Tenovuo O, Theadom A, Tibboel D, Videtta W, Wang KKW, Williams WH, Wilson L, Yaffe K, Adams H, Agnoletti V, Allanson J, Amrein K, Andaluz N, Anke A, Antoni A, van As AB, Audibert G, Azaševac A, Azouvi P, Azzolini ML, Baciu C, Badenes R, Barlow KM, Bartels R, Bauerfeind U, Beauchamp M, Beer D, Beer R, Belda FJ, Bellander BM, Bellier R, Benali H, Benard T, Beqiri V, Beretta L, Bernard F, Bertolini G, Bilotta F, Blaabjerg M, den Boogert H, Boutis K, Bouzat P, Brooks B, Brorsson C, Bullinger M, Burns E, Calappi E, Cameron P, Carise E, Castaño-León AM, Causin F, Chevallard G, Chieregato A, Christie B, Cnossen M, Coles J, Collett J, Della Corte F, Craig W, Csato G, Csomos A, Curry N, Dahyot-Fizelier C, Dawes H, DeMatteo C, Depreitere B, Dewey D, van Dijck J, Đilvesi Đ, Dippel D, Dizdarevic K, Donoghue E, Duek O, Dulière GL, Dzeko A, Eapen G, Emery CA, English S, Esser P, Ezer E, Fabricius M, Feng J, Fergusson D, Figaji A, Fleming J, Foks K, Francony G, Freedman S, Freo U, Frisvold SK, Gagnon I, Galanaud D, Gantner D, Giraud B, Glocker B, Golubovic J, Gómez López PA, Gordon WA, Gradisek P, Gravel J, Griesdale D, Grossi F, Haagsma JA, Håberg AK, Haitsma I, Van Hecke W, Helbok R, Helseth E, van Heugten C, Hoedemaekers C, Höfer S, Horton L, Hui J, Huijben JA, Hutchinson PJ, Jacobs B, van der Jagt M, Jankowski S, Janssens K, Jelaca B, Jones KM, Kamnitsas K, Kaps R, Karan M, Katila A, Kaukonen KM, De Keyser V, Kivisaari R, Kolias AG, Kolumbán B, Kolundžija K, Kondziella D, Koskinen LO, Kovács N, Kramer A, Kutsogiannis D, Kyprianou T, Lagares A, Lamontagne F, Latini R, Lauzier F, Lazar I, Ledig C, Lefering R, Legrand V, Levi L, Lightfoot R, Lozano A, MacDonald S, Major S, Manara A, Manhes P, Maréchal H, Martino C, Masala A, Masson S, Mattern J, McFadyen B, McMahon C, Meade M, Melegh B, Menovsky T, Moore L, Morgado Correia M, Morganti-Kossmann MC, Muehlan H, Mukherjee P, Murray L, van der Naalt J, Negru A, Nelson D, Nieboer D, Noirhomme Q, Nyirádi J, Oddo M, Okonkwo DO, Oldenbeuving AW, Ortolano F, Osmond M, Payen JF, Perlbarg V, Persona P, Pichon N, Piippo-Karjalainen A, Pili-Floury S, Pirinen M, Ple H, Poca MA, Posti J, Van Praag D, Ptito A, Radoi A, Ragauskas A, Raj R, Real RGL, Reed N, Rhodes J, Robertson C, Rocka S, Røe C, Røise O, Roks G, Rosand J, Rosenfeld JV, Rosenlund C, Rosenthal G, Rossi S, Rueckert D, de Ruiter GCW, Sacchi M, Sahakian BJ, Sahuquillo J, Sakowitz O, Salvato G, Sánchez-Porras R, Sándor J, Sangha G, Schäfer N, Schmidt S, Schneider KJ, Schnyer D, Schöhl H, Schoonman GG, Schou RF, Sir Ö, Skandsen T, Smeets D, Sorinola A, Stamatakis E, Stevanovic A, Stevens RD, Sundström N, Taccone FS, Takala R, Tanskanen P, Taylor MS, Telgmann R, Temkin N, Teodorani G, Thomas M, Tolias CM, Trapani T, Turgeon A, Vajkoczy P, Valadka AB, Valeinis E, Vallance S, Vámos Z, Vargiolu A, Vega E, Verheyden J, Vik A, Vilcinis R, Vleggeert-Lankamp C, Vogt L, Volovici V, Voormolen DC, Vulekovic P, Vande Vyvere T, Van Waesberghe J, Wessels L, Wildschut E, Williams G, Winkler MKL, Wolf S, Wood G, Xirouchaki N, Younsi A, Zaaroor M, Zelinkova V, Zemek R, Zumbo F. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol 2017; 16:987-1048. [DOI: 10.1016/s1474-4422(17)30371-x] [Citation(s) in RCA: 822] [Impact Index Per Article: 117.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/06/2017] [Accepted: 09/27/2017] [Indexed: 12/11/2022]
|
18
|
Empfehlung zum Temperaturmanagement nach Atem-Kreislauf-Stillstand und schwerem Schädel-Hirn-Trauma im Kindesalter jenseits der Neonatalperiode. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0306-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
19
|
Stocchetti N, Carbonara M, Citerio G, Ercole A, Skrifvars MB, Smielewski P, Zoerle T, Menon DK. Severe traumatic brain injury: targeted management in the intensive care unit. Lancet Neurol 2017; 16:452-464. [PMID: 28504109 DOI: 10.1016/s1474-4422(17)30118-7] [Citation(s) in RCA: 240] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/20/2017] [Accepted: 03/27/2017] [Indexed: 12/11/2022]
Abstract
Severe traumatic brain injury (TBI) is currently managed in the intensive care unit with a combined medical-surgical approach. Treatment aims to prevent additional brain damage and to optimise conditions for brain recovery. TBI is typically considered and treated as one pathological entity, although in fact it is a syndrome comprising a range of lesions that can require different therapies and physiological goals. Owing to advances in monitoring and imaging, there is now the potential to identify specific mechanisms of brain damage and to better target treatment to individuals or subsets of patients. Targeted treatment is especially relevant for elderly people-who now represent an increasing proportion of patients with TBI-as preinjury comorbidities and their therapies demand tailored management strategies. Progress in monitoring and in understanding pathophysiological mechanisms of TBI could change current management in the intensive care unit, enabling targeted interventions that could ultimately improve outcomes.
Collapse
Affiliation(s)
- Nino Stocchetti
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Anaesthesia and Critical Care, Neuroscience Intensive Care Unit, Milan, Italy; University of Milan, Department of Pathophysiology and Transplants, Milan, Italy.
| | - Marco Carbonara
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Anaesthesia and Critical Care, Neuroscience Intensive Care Unit, Milan, Italy
| | - Giuseppe Citerio
- University of Milan-Bicocca, School of Medicine and Surgery, Milan, Italy; San Gerardo Hospital, Neurointensive Care, ASST, Monza, Italy
| | - Ari Ercole
- Addenbrooke's Hospital, Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Markus B Skrifvars
- Monash University, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Melbourne, VIC, Australia; University of Helsinki and Helsinki University Hospital, Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki, Finland
| | - Peter Smielewski
- University of Cambridge Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge, UK
| | - Tommaso Zoerle
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Anaesthesia and Critical Care, Neuroscience Intensive Care Unit, Milan, Italy
| | - David K Menon
- Addenbrooke's Hospital, Division of Anaesthesia, University of Cambridge, Cambridge, UK
| |
Collapse
|
20
|
Mortality Risk Stratification After Traumatic Brain Injury and Hazard of Death With Titrated Hypothermia in the Eurotherm3235Trial. Crit Care Med 2017; 45:883-890. [PMID: 28277415 PMCID: PMC5389587 DOI: 10.1097/ccm.0000000000002376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Objectives: Hypothermia reduces intracranial hypertension in patients with traumatic brain injury but was associated with harm in the Eurotherm3235Trial. We stratified trial patients by International Mission for Prognosis and Analysis of Clinical Trials in [Traumatic Brain Injury] (IMPACT) extended model sum scores to determine where the balance of risks lay with the intervention. Design: The Eurotherm3235Trial was a randomized controlled trial, with standardized and blinded outcome assessment. Patients in the trial were split into risk tertiles by IMPACT extended model sum scores. A proportional hazard analysis for death between randomization and 6 months was performed by intervention and IMPACT extended model sum scores tertiles in both the intention-to-treat and the per-protocol populations of the Eurotherm3235Trial. Setting: Forty-seven neurologic critical care units in 18 countries. Patients: Adult traumatic brain injury patients admitted to intensive care who had suffered a primary, closed traumatic brain injury; increased intracranial pressure; an initial head injury less than 10 days earlier; a core temperature at least 36°C; and an abnormal brain CT. Intervention: Titrated Hypothermia in the range 32-35°C as the primary intervention to reduce raised intracranial pressure. Measurements and Main Results: Three hundred eighty-six patients were available for analysis in the intention-to-treat and 257 in the per-protocol population. The proportional hazard analysis (intention-to-treat and per-protocol populations) showed that the treatment effect behaves similarly across all risk stratums. However, there is a trend that indicates that patients in the low-risk group could be at greater risk of suffering harm due to hypothermia. Conclusions: Hypothermia as a first line measure to reduce intracranial pressure to less than 20 mm Hg is harmful in patients with a lower severity of injury and no clear benefit exists in patients with more severe injuries.
Collapse
|
21
|
Brenner S, Eich C, Rellensmann G, Schuhmann MU, Nicolai T, Hoffmann F. [Recommendation on temperature management after cardiopulmonary arrest and severe traumatic brain injury in childhood beyond the neonatal period : Statement of the German Society for Neonatology and Pediatric Intensive Care Medicine (GNPI) and the scientific Working Group for Paediatric Anaesthesia (WAKKA) of the German Society of Anaesthesiology and Intensive Care (DGAI)]. Anaesthesist 2017; 66:128-133. [PMID: 28091756 DOI: 10.1007/s00101-016-0256-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The available data on the effectiveness of therapeutic hypothermia in different patient groups are heterogeneous. Although the benefits have been proven for some collectives, recommendations for the use of hypothermia treatment in other groups are based on less robust data and conclusions by analogy. This article gives a review of the current evidence of temperature management in all age groups and based on this state of knowledge, recommends active temperature management with the primary aim of strict normothermia (36-36.5 °C) for 72 hours after cardiopulmonary arrest or severe traumatic brain injury for children beyond the neonatal period.
Collapse
Affiliation(s)
- S Brenner
- Neonatologie und pädiatrische Intensivmedizin, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - C Eich
- Abteilung Anästhesie, Kinderintensiv- und Notfallmedizin, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland
| | - G Rellensmann
- Neonatologie und pädiatrische Intensivmedizin, Klinik für Kinder- und Jugendmedizin - Allgemeine Pädiatrie, Universitätsklinikum Münster, Münster, Deutschland
| | - M U Schuhmann
- Bereich Pädiatrische Neurochirurgie, Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - T Nicolai
- Interdisziplinäre Kinderintensivstation, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, München, Deutschland
| | - F Hoffmann
- Interdisziplinäre Kinderintensivstation, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität München, München, Deutschland
| |
Collapse
|
22
|
Young AMH, Kolias AG, Hutchinson PJ. Decompressive craniectomy for traumatic intracranial hypertension: application in children. Childs Nerv Syst 2017; 33:1745-1750. [PMID: 29149391 PMCID: PMC5587789 DOI: 10.1007/s00381-017-3534-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 01/24/2023]
Abstract
Traumatic brain injury remains prevalent in children, particularly within the adolescent age group. In severe injury, the priority of treatment is to stabilise the patient initially and prevent the evolution of brain swelling and secondary ischaemia using tiers of medical therapy. The final stage of intervention for such patients is a decompressive craniectomy. Here in, we identify the current evidence for performing decompressive crainectomy in children including the results from the RESCUEicp study.
Collapse
Affiliation(s)
- Adam M. H. Young
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital & University of Cambridge, Cambridge, UK ,Department of Academic Neurosurgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
| | - Angelos G. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital & University of Cambridge, Cambridge, UK
| | - Peter J. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital & University of Cambridge, Cambridge, UK
| |
Collapse
|
23
|
|
24
|
|
25
|
Bell MJ, Wisniewski SR. Severe traumatic brain injury in children: a vision for the future. Intensive Care Med 2016; 42:1618-1620. [PMID: 27256038 DOI: 10.1007/s00134-016-4401-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/19/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Michael J Bell
- Department of Critical Care Medicine, Neurological Surgery and Pediatrics, University of Pittsburgh, 3434 Fifth Avenue, 15260, Pittsburgh, PA, USA.
| | | |
Collapse
|