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The management of severe traumatic brain injury in the initial postinjury hours – current evidence and controversies
PURPOSE OF REVIEW: To provide an overview of recent studies discussing novel strategies, controversies, and challenges in the management of severe traumatic brain injury (sTBI) in the initial postinjury hours. RECENT FINDINGS: Prehospital management of sTBI should adhere to Advanced Trauma Life Supp...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624411/ https://www.ncbi.nlm.nih.gov/pubmed/37851061 http://dx.doi.org/10.1097/MCC.0000000000001094 |
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author | Hossain, Iftakher Rostami, Elham Marklund, Niklas |
author_facet | Hossain, Iftakher Rostami, Elham Marklund, Niklas |
author_sort | Hossain, Iftakher |
collection | PubMed |
description | PURPOSE OF REVIEW: To provide an overview of recent studies discussing novel strategies, controversies, and challenges in the management of severe traumatic brain injury (sTBI) in the initial postinjury hours. RECENT FINDINGS: Prehospital management of sTBI should adhere to Advanced Trauma Life Support (ATLS) principles. Maintaining oxygen saturation and blood pressure within target ranges on-scene by anesthetist, emergency physician or trained paramedics has resulted in improved outcomes. Emergency department (ED) management prioritizes airway control, stable blood pressure, spinal immobilization, and correction of impaired coagulation. Noninvasive techniques such as optic nerve sheath diameter measurement, pupillometry, and transcranial Doppler may aid in detecting intracranial hypertension. Osmotherapy and hyperventilation are effective as temporary measures to reduce intracranial pressure (ICP). Emergent computed tomography (CT) findings guide surgical interventions such as decompressive craniectomy, or evacuation of mass lesions. There are no neuroprotective drugs with proven clinical benefit, and steroids and hypothermia cannot be recommended due to adverse effects in randomized controlled trials. SUMMARY: Advancement of the prehospital and ED care that include stabilization of physiological parameters, rapid correction of impaired coagulation, noninvasive techniques to identify raised ICP, emergent surgical evacuation of mass lesions and/or decompressive craniectomy, and temporary measures to counteract increased ICP play pivotal roles in the initial management of sTBI. Individualized approaches considering the underlying pathology are crucial for accurate outcome prediction. |
format | Online Article Text |
id | pubmed-10624411 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-106244112023-11-04 The management of severe traumatic brain injury in the initial postinjury hours – current evidence and controversies Hossain, Iftakher Rostami, Elham Marklund, Niklas Curr Opin Crit Care THE SURGICAL PATIENT: Edited by Marc Maegele PURPOSE OF REVIEW: To provide an overview of recent studies discussing novel strategies, controversies, and challenges in the management of severe traumatic brain injury (sTBI) in the initial postinjury hours. RECENT FINDINGS: Prehospital management of sTBI should adhere to Advanced Trauma Life Support (ATLS) principles. Maintaining oxygen saturation and blood pressure within target ranges on-scene by anesthetist, emergency physician or trained paramedics has resulted in improved outcomes. Emergency department (ED) management prioritizes airway control, stable blood pressure, spinal immobilization, and correction of impaired coagulation. Noninvasive techniques such as optic nerve sheath diameter measurement, pupillometry, and transcranial Doppler may aid in detecting intracranial hypertension. Osmotherapy and hyperventilation are effective as temporary measures to reduce intracranial pressure (ICP). Emergent computed tomography (CT) findings guide surgical interventions such as decompressive craniectomy, or evacuation of mass lesions. There are no neuroprotective drugs with proven clinical benefit, and steroids and hypothermia cannot be recommended due to adverse effects in randomized controlled trials. SUMMARY: Advancement of the prehospital and ED care that include stabilization of physiological parameters, rapid correction of impaired coagulation, noninvasive techniques to identify raised ICP, emergent surgical evacuation of mass lesions and/or decompressive craniectomy, and temporary measures to counteract increased ICP play pivotal roles in the initial management of sTBI. Individualized approaches considering the underlying pathology are crucial for accurate outcome prediction. Lippincott Williams & Wilkins 2023-12 2023-10-11 /pmc/articles/PMC10624411/ /pubmed/37851061 http://dx.doi.org/10.1097/MCC.0000000000001094 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) |
spellingShingle | THE SURGICAL PATIENT: Edited by Marc Maegele Hossain, Iftakher Rostami, Elham Marklund, Niklas The management of severe traumatic brain injury in the initial postinjury hours – current evidence and controversies |
title | The management of severe traumatic brain injury in the initial postinjury hours – current evidence and controversies |
title_full | The management of severe traumatic brain injury in the initial postinjury hours – current evidence and controversies |
title_fullStr | The management of severe traumatic brain injury in the initial postinjury hours – current evidence and controversies |
title_full_unstemmed | The management of severe traumatic brain injury in the initial postinjury hours – current evidence and controversies |
title_short | The management of severe traumatic brain injury in the initial postinjury hours – current evidence and controversies |
title_sort | management of severe traumatic brain injury in the initial postinjury hours – current evidence and controversies |
topic | THE SURGICAL PATIENT: Edited by Marc Maegele |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624411/ https://www.ncbi.nlm.nih.gov/pubmed/37851061 http://dx.doi.org/10.1097/MCC.0000000000001094 |
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