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Brain Shock—Toward Pathophysiologic Phenotyping in Traumatic Brain Injury

Severe traumatic brain injury (TBI) is a heterogeneous pathophysiologic entity where multiple interacting mechanisms are operating. This viewpoint offers an emerging, clinically actionable understanding of the pathophysiologic heterogeneity and phenotypic diversity that comprise secondary brain inju...

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Autor principal: Lazaridis, Christos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257295/
https://www.ncbi.nlm.nih.gov/pubmed/35815183
http://dx.doi.org/10.1097/CCE.0000000000000724
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author Lazaridis, Christos
author_facet Lazaridis, Christos
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description Severe traumatic brain injury (TBI) is a heterogeneous pathophysiologic entity where multiple interacting mechanisms are operating. This viewpoint offers an emerging, clinically actionable understanding of the pathophysiologic heterogeneity and phenotypic diversity that comprise secondary brain injury based on multimodality neuromonitoring data. This pathophysiologic specification has direct implications for diagnostic, monitoring, and therapeutic planning. Cerebral shock can be helpfully subanalyzed into categories via an examination of the different types of brain tissue hypoxia and substrate failure: a) ischemic or flow dependent; b) flow-independent, which includes oxygen diffusion limitation, mitochondrial failure, and arteriovenous shunt; c) low extraction; and d) hypermetabolic. This approach could lead to an alternative treatment paradigm toward optimizing cerebral oxidative metabolism and energy crisis avoidance. Our bedside approach to TBI should respect the pathophysiologic diversity involved; operationalizing it in types of “brain shock” can be one such approach.
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spelling pubmed-92572952022-07-07 Brain Shock—Toward Pathophysiologic Phenotyping in Traumatic Brain Injury Lazaridis, Christos Crit Care Explor Commentary Severe traumatic brain injury (TBI) is a heterogeneous pathophysiologic entity where multiple interacting mechanisms are operating. This viewpoint offers an emerging, clinically actionable understanding of the pathophysiologic heterogeneity and phenotypic diversity that comprise secondary brain injury based on multimodality neuromonitoring data. This pathophysiologic specification has direct implications for diagnostic, monitoring, and therapeutic planning. Cerebral shock can be helpfully subanalyzed into categories via an examination of the different types of brain tissue hypoxia and substrate failure: a) ischemic or flow dependent; b) flow-independent, which includes oxygen diffusion limitation, mitochondrial failure, and arteriovenous shunt; c) low extraction; and d) hypermetabolic. This approach could lead to an alternative treatment paradigm toward optimizing cerebral oxidative metabolism and energy crisis avoidance. Our bedside approach to TBI should respect the pathophysiologic diversity involved; operationalizing it in types of “brain shock” can be one such approach. Lippincott Williams & Wilkins 2022-07-01 /pmc/articles/PMC9257295/ /pubmed/35815183 http://dx.doi.org/10.1097/CCE.0000000000000724 Text en Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. 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) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , 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.
spellingShingle Commentary
Lazaridis, Christos
Brain Shock—Toward Pathophysiologic Phenotyping in Traumatic Brain Injury
title Brain Shock—Toward Pathophysiologic Phenotyping in Traumatic Brain Injury
title_full Brain Shock—Toward Pathophysiologic Phenotyping in Traumatic Brain Injury
title_fullStr Brain Shock—Toward Pathophysiologic Phenotyping in Traumatic Brain Injury
title_full_unstemmed Brain Shock—Toward Pathophysiologic Phenotyping in Traumatic Brain Injury
title_short Brain Shock—Toward Pathophysiologic Phenotyping in Traumatic Brain Injury
title_sort brain shock—toward pathophysiologic phenotyping in traumatic brain injury
topic Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257295/
https://www.ncbi.nlm.nih.gov/pubmed/35815183
http://dx.doi.org/10.1097/CCE.0000000000000724
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