Traumatic Brain Injury: Difference between revisions
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| style="width: 15%; vertical-align: top;" | [[Milan Consensus]] | | style="width: 15%; vertical-align: top;" | [[Milan Consensus]] | ||
| style="width: 85%; vertical-align: top;" | ICP monitoring in severe adult TBI - not recommended for comatose pts /w nml initial CT; recommended for pts w/ bifrontal contusions, s/p 2° DC, WUT is c/i<i>(Acta Neurochir 2014)</i> | | style="width: 85%; vertical-align: top;" | ICP monitoring in severe adult TBI - <u>not recommended</u> for comatose pts /w <span style="background-color:#fff2cc;">nml initial CT that can be f/u Px</span>; <u>recommended</u> for pts w/ <span style="background-color:#fff2cc;">bifrontal contusions, s/p 2° DC, WUT is c/i</span> <i>(Acta Neurochir 2014)</i> | ||
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[[Category:Neurotrauma]] | [[Category:Neurotrauma]] | ||
Revision as of 18:56, 25 July 2024
Pathophysiology
Edema/ICP Elevation
After severe TBI w/ ↑ ICP → ⊕ feedback loop can ensue, leading ultimately to brain death.
This situation can be likened to a compartment syndrome w/i the noncompliant skull.
↑ of ICP (A) → impedes CBF → ischemia → cytotoxic edema caused in part by ATP–dependent Na+-K+ pump failure.
This in turn further ↑ ICP & ↓ CBF.
This situation can ultimately progress to brain death if ICP becomes so high that the cerebrum is not perfused.
Articles
Key articles
| IMPACT Study | ✓ the value of different prognostic factors in TBI ⇒ the most powerful independent prognostic variables identified were age, GCS motor score, pupil response, and CT finding (Marshall classification), labs (PT & glu) (J Neurotrauma. 2007) |
| CRASH trial | ✓ effect of early steroids Rx in adults /w TBI ⇒ ↑ death compared to placebo. (Lancet 2004) |
| CRASH-2 | ✓ the effects of early TXA Rx in TBI pts /w significant haemorrhage ⇒ ↓ mortality & death d/t bleeding w/o ↑ vascular occlusive events (Lancet 2010) |
| DECRA | Efficacy of DC in severe TBI /w refractory ↑ ICP ⇒ DC ↓ ICP & ↓ ICU stay; assoc. /w worse fnx o/c at 6 mn. (N Engl J Med 2011) |
| RESCUEicp | ✓ effectiveness of DC in pts /w TBI & refractory ↑ ICP ⇒ DC ↓ mortality; ↑ risk of severe disability & vegetative state compared to medical Tx alone. (N Engl J Med 2016) |
| BEST-TRIP | ✓ ICP monitoring in pts /w severe TBI improves o/c ⇒ ICP focused Tx was not better to care based on CT and Px → routine ICP monitoring does not provide additional benefits for pts o/c (N Engl J Med 2012) |
| Milan Consensus | ICP monitoring in severe adult TBI - not recommended for comatose pts /w nml initial CT that can be f/u Px; recommended for pts w/ bifrontal contusions, s/p 2° DC, WUT is c/i (Acta Neurochir 2014) |