Clinical Study of Dexmedetomidine in Combination with Butorphanol for the Treatment of Traumatic Brain Injury (TBI)

Research progress of postoperative delirium in neurosurgery

Delirium is a transient and acute syndrome of encephalopathy, characterized by disturbances in consciousness, orientation, cognition, perception, and emotional regulation, often accompanied by hallucinations, illusions, psychomotor agitation, and restlessness. Postoperative delirium (POD), a common complication particularly in elderly patients, significantly impacts recovery by prolonging mechanical ventilation, neurosurgical intensive care unit stays, and overall hospitalization durations, while severely diminishing patients' quality of life after discharge. Despite its prevalence, POD remains underrecognized in clinical practice, with significant gaps in its diagnosis and management. This review explores the definition, diagnostic criteria, underlying pathogenesis, and associated risk factors of POD in neurosurgical patients, aiming to offer valuable insights for improving clinical diagnosis and therapeutic strategies.

Feasibility study on intracranial pressure and prognosis of patients with moderate and severe craniocerebral injury using the Rotterdam computed tomography score: an observational study

Objective

The Rotterdam computed tomography (CT) score was used to evaluate the degree of coma and the prognosis of patients with moderate and severe craniocerebral injury, to analyze its feasibility, and to assess its value in guiding further clinical applications.

Methods

A total of 120 patients with moderate-to-severe craniocerebral injuries were selected as study participants, all of whom were treated at the Department of Neurosurgery of the Second Affiliated Hospital of Nantong University. All 120 patients underwent craniocerebral CT scans. The Glasgow Coma Scale was used to evaluate the degree of coma, and the Glasgow Outcome Scale was used to evaluate prognosis. The Rotterdam CT scores of patients with different degrees of coma and prognoses were compared.

Results

The Rotterdam CT score was significantly lower in patients with moderate coma than in those with severe coma (p < 0.05). The Rotterdam CT score of patients with a good prognosis was significantly lower than that of patients with a poor prognosis (p < 0.05).

Conclusion

The Rotterdam CT score is indicative of the degree of coma in patients with moderate and severe craniocerebral injuries and has prognostic value. The Rotterdam CT score also shows potential for broader clinical application.

Association of Early Dexmedetomidine Utilization With Clinical Outcomes After Moderate-Severe Traumatic Brain Injury: A Retrospective Cohort Study

BACKGROUND

Traumatic brain injury (TBI) is an expensive and common public health problem. Management of TBI oftentimes includes sedation to facilitate mechanical ventilation (MV) for airway protection. Dexmedetomidine has emerged as a potential candidate for improved patient outcomes when used for early sedation after TBI due to its potential modulation of autonomic dysfunction. We examined early sedation patterns, as well as the association of dexmedetomidine exposure with clinical and functional outcomes among mechanically ventilated patients with moderate-severe TBI (msTBI) in the United States.

METHODS

We conducted a retrospective cohort study using data from the Premier dataset and identified a cohort of critically ill adult patients with msTBI who required MV from January 2016 to June 2020. msTBI was defined by head-neck abbreviated injury scale (AIS) values of 3 (serious), 4 (severe), and 5 (critical). We described early continuous sedative utilization patterns. Using propensity-matched models, we examined the association of early dexmedetomidine exposure (within 2 days of intensive care unit [ICU] admission) with the primary outcome of hospital mortality and the following secondary outcomes: hospital length of stay (LOS), days on MV, vasopressor use after the first 2 days of admission, hemodialysis (HD) after the first 2 days of admission, hospital costs, and discharge disposition. All medications, treatments, and procedures were identified using date-stamped hospital charge codes.

RESULTS

The study population included 19,751 subjects who required MV within 2 days of ICU admission. The patients were majority male and white. From 2016 to 2020, the annual percent utilization of dexmedetomidine increased from 4.05% to 8.60%. After propensity score matching, early dexmedetomidine exposure was associated with reduced odds of hospital mortality (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.47-0.74; P < .0001), increased risk for liberation from MV (hazard ratio [HR], 1.20; 95% CI, 1.09-1.33; P = .0003), and reduced LOS (HR, 1.11; 95% CI, 1.01-1.22; P = .033). Exposure to early dexmedetomidine was not associated with odds of HD (OR, 1.14; 95% CI, 0.73-1.78; P = .56), vasopressor utilization (OR, 1.10; 95% CI, 0.78-1.55; P = .60), or increased hospital costs (relative cost ratio, 1.98; 95% CI, 0.93-1.03; P = .66).

CONCLUSIONS

Dexmedetomidine is being utilized increasingly as a sedative for mechanically ventilated patients with msTBI. Early dexmedetomidine exposure may lead to improved patient outcomes in this population.