1
|
Zhao J, Fan K, Zheng S, Xie G, Niu X, Pang J, Zhang H, Wu X, Qu J. Effect of occupational therapy on the occurrence of delirium in critically ill patients: a systematic review and meta-analysis. Front Neurol 2024; 15:1391993. [PMID: 39105057 PMCID: PMC11298357 DOI: 10.3389/fneur.2024.1391993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/12/2024] [Indexed: 08/07/2024] Open
Abstract
Aim Delirium poses a major challenge to global health care, yet there is currently a dearth of single effective interventions or medications. Particularly, addressing delirium induced by critical illness is a complex process. Occupational therapy is considered to have a high potential for use in the prevention of delirium, as it involves both cognitive training and training in ADL. To comprehensively analyze the effect of occupational therapy on delirium prevention, we evaluated the effects of occupational therapy vs. standard non-pharmacological prevention on incidence and duration of delirium, clinical outcomes and rehabilitation outcomes in critically ill patients. Methods The data sources, including PubMed/Medline, Web of Science, EMBASE, and Cochrane Library, were comprehensively searched from their inception until 15 October 2023. Following the PICOS principle, a systematic screening of literature was conducted to identify relevant studies. Subsequently, the quality assessment was performed to evaluate the risk of bias in the included literature. Finally, outcome measures from each study were extracted and comprehensive analysis was conducted using Review Manager 5.4. Results A total of four clinical trials met the selection criteria. The pooled analysis indicated no significant difference in the incidence and duration of delirium between the OT group and standard non-pharmacological interventions. A comprehensive analysis of clinical outcomes revealed that OT did not significantly reduce the length of hospital stay or ICU stay. Meanwhile, there was no significant difference in mortality rates between the two groups. It is noteworthy that although grip strength levels did not exhibit significant improvement following OT intervention, there were obvious enhancements observed in ADL and MMSE scores. Conclusion Although occupational therapy may not be the most effective in preventing delirium, it has been shown to significantly improve ADL and cognitive function among critically ill patients. Therefore, we contend that occupational therapy is a valuable component of a comprehensive multidisciplinary approach to managing delirium. In the future, high-quality researches are warranted to optimize the implementation of occupational therapy interventions for delirium prevention and further enhance their benefits for patients.
Collapse
Affiliation(s)
- Jun Zhao
- Rehabilitation Assessment and Treatment Center, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- School of Rehabilitation Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Kaipeng Fan
- Department of Rehabilitation, Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
| | - Suqin Zheng
- Rehabilitation Assessment and Treatment Center, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- School of Rehabilitation Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Guangyao Xie
- Rehabilitation Assessment and Treatment Center, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- School of Rehabilitation Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xuekang Niu
- Rehabilitation Assessment and Treatment Center, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- School of Rehabilitation Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jinkuo Pang
- Rehabilitation Assessment and Treatment Center, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- School of Rehabilitation Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huihuang Zhang
- Rehabilitation Assessment and Treatment Center, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- School of Rehabilitation Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xin Wu
- Rehabilitation Assessment and Treatment Center, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- School of Rehabilitation Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiayang Qu
- Rehabilitation Assessment and Treatment Center, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- School of Rehabilitation Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| |
Collapse
|
2
|
How Important Are Arterial Blood Gas Parameters for Severe Head Trauma in Children? JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1016696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
3
|
Liu Q, Xu X. Cognition of Nurses in Neurology Department on Rehabilitation Nursing. Transl Neurosci 2019; 10:25-30. [PMID: 31098308 PMCID: PMC6487783 DOI: 10.1515/tnsci-2019-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/28/2019] [Indexed: 11/15/2022] Open
Abstract
Stroke has become a major disease seriously threating human health due to its high morbidity, mortality and disability. Rehabilitation nursing care for stroke patients has always been a key part of clinical care. The neurological nursing managers should pay high attention to the issue about how to more effectively improve the level of nurses’ rehabilitation nursing on stroke patients. Therefore, this paper investigates the current cognition of neurological nurses about stroke knowledge, attitude and behaviour, and then analyses the factors affecting the knowledge, attitude and behaviour of stroke in the nurses, in order to provide better nursing services for stroke patients, and improve their nursing quality. The findings show that the different cognitions of nurses about their role have different effects on the knowledge, attitudes and behavioural levels of the neurological nurses; the nurses with more types of roles have better knowledge and behavioural levels of stroke.
Collapse
Affiliation(s)
- Qie Liu
- Department of Neurology, Daqing Oilfield General Hospital, Daqing 163001, China
| | - Xin Xu
- Department of Neurology, Daqing Oilfield General Hospital, Daqing 163001, China
| |
Collapse
|
4
|
Marklund N. Neuroendoscopy-a minimally invasive alternative in the surgical management of traumatic intracerebral contusions? Acta Neurochir (Wien) 2019; 161:231-232. [PMID: 30666452 DOI: 10.1007/s00701-019-03813-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Niklas Marklund
- Skåne University Hospital, Department of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, Sweden.
| |
Collapse
|
5
|
Lazaridis C, Rusin CG, Robertson CS. Secondary brain injury: Predicting and preventing insults. Neuropharmacology 2018; 145:145-152. [PMID: 29885419 DOI: 10.1016/j.neuropharm.2018.06.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/07/2018] [Accepted: 06/04/2018] [Indexed: 11/17/2022]
Abstract
Mortality or severe disability affects the majority of patients after severe traumatic brain injury (TBI). Adherence to the brain trauma foundation guidelines has overall improved outcomes; however, traditional as well as novel interventions towards intracranial hypertension and secondary brain injury have come under scrutiny after series of negative randomized controlled trials. In fact, it would not be unfair to say there has been no single major breakthrough in the management of severe TBI in the last two decades. One plausible hypothesis for the aforementioned failures is that by the time treatment is initiated for neuroprotection, or physiologic optimization, irreversible brain injury has already set in. We, and others, have recently developed predictive models based on machine learning from continuous time series of intracranial pressure and partial brain tissue oxygenation. These models provide accurate predictions of physiologic crises events in a timely fashion, offering the opportunity for an earlier application of targeted interventions. In this article, we review the rationale for prediction, discuss available predictive models with examples, and offer suggestions for their future prospective testing in conjunction with preventive clinical algorithms. This article is part of the Special Issue entitled "Novel Treatments for Traumatic Brain Injury".
Collapse
Affiliation(s)
- Christos Lazaridis
- Division of Neurocritical Care, Department of Neurology, Baylor College of Medicine, Houston, TX, United States; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States.
| | - Craig G Rusin
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, United States
| | - Claudia S Robertson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States.
| |
Collapse
|
6
|
Gutierrez-Aceves GA, Sosa-Najera A, Ceja-Espinosa A, Jimenez JAF, Horus MM, Ibarra-Trujillo G, Tevera-Ovando C, Saucillo-Lopez DM. Posterior bi-parietal decompressive craniectomy in refractory intracranial hypertension secondary to civilian gunshot wound. Case report and review of literature. Int J Surg Case Rep 2018; 53:291-294. [PMID: 30466037 PMCID: PMC6251062 DOI: 10.1016/j.ijscr.2018.10.045] [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: 09/12/2018] [Revised: 10/06/2018] [Accepted: 10/14/2018] [Indexed: 11/23/2022] Open
Abstract
Decompressive craniectomy is the therapy for unresponsive intracranial hypertension in Traumatic Brain Injury. There have been reports of a Bi-Occipital craniectomy in cases where the focal injury is posterior. Bi-parietal craniectomy can be performed in a safe way with acceptable results to treat refractory Intracranial hypertension.
Background Decompressive craniectomy is recommended as second tier therapy for unresponsive intracranial hypertension in Traumatic Brain Injury. There have been reports of a Bi-Occipital craniectomy in cases where the focal injury is posterior. Case description The work has been reported in line with the SCARE criteria. There is a 56-year-old male with Traumatic brain injury secondary to gunshot and intracranial hypertension, managed with biparietal craniectomy, after place a intracranial pressure monitor, whit good response to surgical and medical treatment, even with good outcome after hospitalization. Conclusions In selected cases a posterior bi-parietal craniectomy can be performed in a safe way with acceptable results to treat refractory Intracranial hypertension. We propose that this neurosurgical technique can be used in patients with posterior focal injuries.
Collapse
|
7
|
Herbert JP, Guillotte AR, Hammer RD, Litofsky NS. Coagulopathy in the Setting of Mild Traumatic Brain Injury: Truths and Consequences. Brain Sci 2017; 7:brainsci7070092. [PMID: 28737691 PMCID: PMC5532605 DOI: 10.3390/brainsci7070092] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 07/09/2017] [Accepted: 07/18/2017] [Indexed: 12/03/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is a common, although poorly-defined clinical entity. Despite its initially mild presentation, patients with mTBI can rapidly deteriorate, often due to significant expansion of intracranial hemorrhage. TBI-associated coagulopathy is the topic of significant clinical and basic science research. Unlike trauma-induced coagulopathy (TIC), TBI-associated coagulopathy does not generally follow widespread injury or global hypoperfusion, suggesting a distinct pathogenesis. Although the fundamental mechanisms of TBI-associated coagulopathy are far from clearly elucidated, several candidate molecules (tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), tissue factor (TF), and brain-derived microparticles (BDMP)) have been proposed which might explain how even minor brain injury can induce local and systemic coagulopathy. Here, we review the incidence, proposed mechanisms, and common clinical tests relevant to mTBI-associated coagulopathy and briefly summarize our own institutional experience in addition to identifying areas for further research.
Collapse
Affiliation(s)
- Joseph P Herbert
- Division of Neurological Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA.
| | - Andrew R Guillotte
- Division of Neurological Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA.
| | - Richard D Hammer
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO 65212, USA.
| | - N Scott Litofsky
- Division of Neurological Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA.
| |
Collapse
|
8
|
Saadoun S, Papadopoulos MC. Spinal cord injury: is monitoring from the injury site the future? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:308. [PMID: 27716379 PMCID: PMC5050726 DOI: 10.1186/s13054-016-1490-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper challenges the current management of acute traumatic spinal cord injury based on our experience with monitoring from the injury site in the neurointensive care unit. We argue that the concept of bony decompression is inadequate. The concept of optimum spinal cord perfusion pressure, which differs between patients, is introduced. Such variability suggests individualized patient treatment. Failing to optimize spinal cord perfusion limits the entry of systemically administered drugs into the injured cord. We conclude that monitoring from the injury site helps optimize management and should be subjected to a trial to determine whether it improves outcome.
Collapse
Affiliation(s)
- Samira Saadoun
- Academic Neurosurgery Unit, St. George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | - Marios C Papadopoulos
- Academic Neurosurgery Unit, St. George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK.
| |
Collapse
|
9
|
Adams H, Kolias AG, Hutchinson PJ. The Role of Surgical Intervention in Traumatic Brain Injury. Neurosurg Clin N Am 2016; 27:519-28. [DOI: 10.1016/j.nec.2016.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
10
|
Jeffcote T, Hinzman JM, Jewell SL, Learney RM, Pahl C, Tolias C, Walsh DC, Hocker S, Zakrzewska A, Fabricius ME, Strong AJ, Hartings JA, Boutelle MG. Detection of Spreading Depolarization with Intraparenchymal Electrodes in the Injured Human Brain. Neurocrit Care 2013; 20:21-31. [DOI: 10.1007/s12028-013-9938-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
11
|
Walcott BP, Kahle KT, Simard JM. The DECRA trial and decompressive craniectomy in diffuse traumatic brain injury: is decompression really ineffective? World Neurosurg 2012; 79:80-1. [PMID: 23159659 DOI: 10.1016/j.wneu.2012.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 11/09/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Brian P Walcott
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | | | | |
Collapse
|
12
|
Catroppa C, Soo C, Crowe L, Woods D, Anderson V. Evidence-based approaches to the management of cognitive and behavioral impairments following pediatric brain injury. FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.12.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Much is now known about the short- and long-term sequelae of pediatric acquired brain injury, with impairments found in general intellectual ability and in more specific domains, including attention, memory, executive functioning (e.g., planning and organization) and educational achievement (e.g., spelling and arithmetic). More recently, researchers have investigated behavioral, adaptive, social and mental health outcomes, and similarly, difficulties have been reported in these domains. While the availability of evidence-based treatments is currently limited, the need for the management of such sequelae has led to an emergence of research with a focus on the development and evaluation of management strategies and intervention programs in order to provide such treatment options.
Collapse
Affiliation(s)
- Cathy Catroppa
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Cheryl Soo
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Louise Crowe
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
- University of Melbourne, Victoria, 3010, Australia
| | - Damith Woods
- Department of Paediatric Rehabilitation, Women’s & Children’s Hospital, 72 King William Road, North Adelaide, SA 5006, Australia
| | - Vicki Anderson
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
- Royal Children’s Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
- University of Melbourne, Victoria, 3010, Australia
| |
Collapse
|
13
|
Affiliation(s)
- Roland Torres
- Department of Neurosurgery, Stanford Univ. Medical School, Stanford, USA
| |
Collapse
|
14
|
|
15
|
Tran ND, Kim S, Vincent HK, Rodriguez A, Hinton DR, Bullock MR, Young HF. Aquaporin-1-mediated cerebral edema following traumatic brain injury: effects of acidosis and corticosteroid administration. J Neurosurg 2010; 112:1095-104. [PMID: 19731985 DOI: 10.3171/2009.8.jns081704] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECT Dysregulation of water homeostasis induces cerebral edema. Edema is a major cause of morbidity and mortality following traumatic brain injury (TBI). Aquaporin-1 (AQP-1), a water channel found in the brain, can function as a transporter for CO2 across the cellular membrane. Additionally, AQP-1's promoter contains a glucocorticoid response element. Thus, AQP-1 may be involved with edema-related brain injury and might be modulated by external conditions such as the pH and the presence of steroids. In this study, the authors investigated the hypotheses that: 1) AQP-1 participates in brain water homeostasis following TBI; 2) secondary injury (for example, acidosis) alters the expression of AQP-1 and exacerbates cerebral edema; and 3) corticosteroids augment brain AQP-1 expression and differentially affect cerebral edema under nonacidotic and acidotic conditions. METHODS Anesthetized Sprague-Dawley rats were subjected to moderate to severe TBI (2.5-3.5 atm) or surgery without injury, and they were randomized to receive a 3-mg/kg bolus of intravenous dexamethasone within 10 minutes after injury or surgery, a 3-mg/kg bolus of dexamethasone followed by 1-mg/kg maintenance doses every 8 hours for 24 hours, or saline boluses at similar time intervals. A second group of animals was subjected to respiratory acidosis with target arterial blood pH 6.8-7.2 for 1 hour following the surgery or injury. To evaluate selective blockage of AQP-1, some animals received a single intraperitoneal dose of HgCl2 (0.3-30.0 mmol/L) within 30 minutes of injury or surgery. At 4 or 24 hours postinjury, animals were killed and their brains were harvested for mRNA, protein, or water content analyses. RESULTS The authors demonstrated elevated cerebral edema levels at 4 and 24 hours following TBI. Dexamethasone administration within 1 hour of TBI attenuated the cerebral edema under nonacidotic conditions but worsened it under acidotic conditions. Selective blockage of AQP-1 channels with HgCl2 attenuated the edematous effects of corticosteroids and acidosis. Reverse transcriptase polymerase chain reaction and immunohistochemical analyses demonstrated a paucity of AQP-1 in the cerebral cortices of the uninjured animals. In contrast, AQP-1 mRNA and protein levels were higher in the cerebral cortices of animals that sustained a TBI. CONCLUSIONS These findings implicate an important, modifiable role for AQP-1 in water homeostasis within the CNS following TBI.
Collapse
Affiliation(s)
- Nam D Tran
- Department of Neurosurgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, USA.
| | | | | | | | | | | | | |
Collapse
|
16
|
Skoglund K, Enblad P, Marklund N. Effects of the neurological wake-up test on intracranial pressure and cerebral perfusion pressure in brain-injured patients. Neurocrit Care 2009; 11:135-42. [PMID: 19644774 DOI: 10.1007/s12028-009-9255-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 07/21/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effects of the neurological "wake-up test" (NWT), defined as interruption of continuous propofol sedation and evaluation of the patient's level of consciousness, on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patients with severe subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI). METHODS A total of 127 NWT procedures in 21 severely brain-injured adult patients with either TBI (n = 12) or SAH (n = 9) were evaluated. ICP and CPP levels prior to, during and after the NWT procedure were recorded. RESULTS During the NWT, ICP increased from 13.4 +/- 6 mmHg at baseline to 22.7 +/- 12 (P < 0.05) and the CPP increased from 75.6 +/- 11 to 79.1 +/- 21 mmHg (P < 0.05) in TBI patients. Eight patients showed a reduced CPP during the NWT due to increased ICP. In SAH patients, ICP increased from 10.6 +/- 5 to 16.8 +/- 8 mmHg (P < 0.05) and the CPP increased from 76.9 +/- 13 to 84.6 +/- 15 mmHg (P < 0.05). CONCLUSION When continuous propofol sedation was interrupted and NWT was performed in severely brain-injured patients, the mean ICP and CPP levels were modestly increased. A subset of patients showed more pronounced changes. To date, the role of the NWT in the neurointensive care of TBI and SAH patients is unclear. Although the NWT is safe in the majority of patients and may provide useful clinical information about the patient's level of consciousness, alternate monitoring methods are suggested in patients showing marked ICP and/or CPP changes during NWT.
Collapse
Affiliation(s)
- Karin Skoglund
- Department of Neuroscience, Neurosurgery, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | | | | |
Collapse
|
17
|
Chieregato A, Noto A, Tanfani A, Bini G, Martino C, Fainardi E. Hyperemia beneath evacuated acute subdural hematoma is frequent and prolonged in patients with an unfavorable outcome: a xe-computed tomographic study. Neurosurgery 2009; 64:705-17; discussion 717-8. [PMID: 19349828 DOI: 10.1227/01.neu.0000341872.17024.44] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To verify the values and the time course of regional cerebral blood flow (rCBF) in the cortex located beneath an evacuated acute subdural hematoma (SDH) and their relationship with neurological outcome. METHODS rCBF levels were measured in multiple regions of interest, by means of a Xe-computed tomographic technique, in the cortex underlying an evacuated SDH and contralaterally in 20 patients with moderate or severe traumatic brain injury and an evacuated acute SDH. Twenty-three patients with moderate or severe traumatic brain injury and an evacuated extradural hematoma or diffuse injury served as the control group. Outcome was evaluated by means of the Glasgow Outcome Scale at 12 months. RESULTS Values for the maximum (rCBFmax) and the mean of all rCBF levels in the cortex beneath the evacuated SDH were more frequently consistent with hyperemia. The side-to-side differences in the mean of all rCBF and rCBFmax levels between lesioned and nonlesioned hemispheres were greater in patients with evacuated SDH than in controls (P = 0.0013 and P = 0.0018, respectively). The side-to-side difference in the maximum rCBF value was higher in SDH patients with unfavorable outcomes than in controls at 24 to 96 hours and at 4 to 7 days and higher than in patients with favorable outcomes at 4 to 7 days. The widest side-to-side difference in rCBFmax value was more elevated in patients with an evacuated SDH with unfavorable outcome than in patients with a favorable outcome (P = 0.047), whereas no differences were found in controls. The SDH thickness and the associated midline shift were greater in patients with unfavorable outcomes than in those with favorable outcomes. CONCLUSION On average, hyperemic long-lasting rCBF values frequently occur in the cortex located beneath an evacuated SDH and seem to be associated with unfavorable outcome.
Collapse
Affiliation(s)
- Arturo Chieregato
- Neurosurgical and Trauma Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
| | | | | | | | | | | |
Collapse
|
18
|
Guerrero-López F, Miñambres E. Punto y seguido. Med Intensiva 2009; 33:182-4. [DOI: 10.1016/s0210-5691(09)71214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
19
|
Tang ME, Lobel DA. Severe traumatic brain injury: maximizing outcomes. ACTA ACUST UNITED AC 2009; 76:119-28. [DOI: 10.1002/msj.20106] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
20
|
|