Perioperative Management of Severe Traumatic Brain Injury: What Is New?

Overview

Journal Curr Anesthesiol Rep

Publisher Current Science

Specialty Anesthesiology

Date 2018 Aug 28

PMID 30147453

Citations 10

Authors

Deacon Farrell

Audree A Bendo

Affiliations

Soon will be listed here.

Abstract

Purpose Of The Review: Severe traumatic brain injury (TBI) continues to represent a global public health issue, and mortality and morbidity in TBI patients remain substantial. There are ongoing international collaborations to provide guidelines for perioperative care and management of severe TBI patients. In addition, new pharmacologic agents are being tested along with cognitive rehabilitation to improve functional independence and outcome in TBI patients. This review will discuss the current updates in the guidelines for the perioperative management of TBI patients and describe potential new therapies to improve functional outcomes.

Recent Findings: In the most recent guidelines published by The Brain Trauma Foundation, therapeutic options were reviewed based on new and revised evidence or lack of evidence. For example, changes and/or updates were made to the recommendations for the use of sedation and hypothermia in TBI patients, and new evidence was provided for the use of cerebrospinal fluid drainage as a first-line treatment for increased intracranial pressure (ICP). In addition to the guidelines, new 'multi-potential' agents that can target several mechanisms are being tested along with cognitive rehabilitation.

Summary: The major goal of perioperative management of TBI patients is to prevent secondary damage. Therapeutic measures based on established guidelines and recommendations must be instituted promptly throughout the perioperative course to reduce morbidity and mortality.

Citing Articles

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Effect of erythropoietin on SOFA score, Glasgow Coma Scale and mortality in traumatic brain injury patients: a randomized-double-blind controlled trial.

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References

Kerr E, Marion D, Sereika M, Weber B, Orndoff A, Henker R . The effect of cerebrospinal fluid drainage on cerebral perfusion in traumatic brain injured adults. J Neurosurg Anesthesiol. 2001; 12(4):324-33. DOI: 10.1097/00008506-200010000-00005. View

Beauchamp K, Mutlak H, Smith W, Shohami E, Stahel P . Pharmacology of traumatic brain injury: where is the "golden bullet"?. Mol Med. 2008; 14(11-12):731-40. PMC: 2527342. DOI: 10.2119/2008-00050.Beauchamp. View

Bar-Joseph G, Guilburd Y, Tamir A, Guilburd J . Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension. J Neurosurg Pediatr. 2009; 4(1):40-6. DOI: 10.3171/2009.1.PEDS08319. View

Bryant R . Post-traumatic stress disorder vs traumatic brain injury. Dialogues Clin Neurosci. 2011; 13(3):251-62. PMC: 3182010. View

Knoller N, Levi L, Shoshan I, Reichenthal E, Razon N, Rappaport Z . Dexanabinol (HU-211) in the treatment of severe closed head injury: a randomized, placebo-controlled, phase II clinical trial. Crit Care Med. 2002; 30(3):548-54. DOI: 10.1097/00003246-200203000-00009. View

Rose F, Brooks B, Rizzo A . Virtual reality in brain damage rehabilitation: review. Cyberpsychol Behav. 2005; 8(3):241-62. DOI: 10.1089/cpb.2005.8.241. View

Mechoulam R, Spatz M, Shohami E . Endocannabinoids and neuroprotection. Sci STKE. 2002; 2002(129):re5. DOI: 10.1126/stke.2002.129.re5. View

Giacino J, Whyte J, Bagiella E, Kalmar K, Childs N, Khademi A . Placebo-controlled trial of amantadine for severe traumatic brain injury. N Engl J Med. 2012; 366(9):819-26. DOI: 10.1056/NEJMoa1102609. View

Seguin P, Laviolle B, Dahyot-Fizelier C, Dumont R, Veber B, Gergaud S . Effect of oropharyngeal povidone-iodine preventive oral care on ventilator-associated pneumonia in severely brain-injured or cerebral hemorrhage patients: a multicenter, randomized controlled trial. Crit Care Med. 2013; 42(1):1-8. DOI: 10.1097/CCM.0b013e3182a2770f. View

10.

Feigenbaum J, Bergmann F, Richmond S, Mechoulam R, Nadler V, Kloog Y . Nonpsychotropic cannabinoid acts as a functional N-methyl-D-aspartate receptor blocker. Proc Natl Acad Sci U S A. 1989; 86(23):9584-7. PMC: 298542. DOI: 10.1073/pnas.86.23.9584. View

11.

Peeters M, Page G, Maloteaux J, Hermans E . Hypersensitivity of dopamine transmission in the rat striatum after treatment with the NMDA receptor antagonist amantadine. Brain Res. 2002; 949(1-2):32-41. DOI: 10.1016/s0006-8993(02)02961-x. View

12.

Kourbeti I, Vakis A, Papadakis J, Karabetsos D, Bertsias G, Filippou M . Infections in traumatic brain injury patients. Clin Microbiol Infect. 2011; 18(4):359-64. DOI: 10.1111/j.1469-0691.2011.03625.x. View

13.

Steiger H, Aaslid R, Stooss R, Seiler R . Transcranial Doppler monitoring in head injury: relations between type of injury, flow velocities, vasoreactivity, and outcome. Neurosurgery. 1994; 34(1):79-85; discussion 85-6. View

14.

Gaab M, Trost H, Alcantara A, KARIMI-NEJAD A, Moskopp D, Schultheiss R . "Ultrahigh" dexamethasone in acute brain injury. Results from a prospective randomized double-blind multicenter trial (GUDHIS). German Ultrahigh Dexamethasone Head Injury Study Group. Zentralbl Neurochir. 1994; 55(3):135-43. View

15.

Qiu W, Guo C, Shen H, Chen K, Wen L, Huang H . Effects of unilateral decompressive craniectomy on patients with unilateral acute post-traumatic brain swelling after severe traumatic brain injury. Crit Care. 2009; 13(6):R185. PMC: 2811943. DOI: 10.1186/cc8178. View

16.

. Guidelines for the management of severe head injury. Brain Trauma Foundation, American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. J Neurotrauma. 1996; 13(11):641-734. DOI: 10.1089/neu.1996.13.641. View

17.

Lump D, Moyer M . Paroxysmal sympathetic hyperactivity after severe brain injury. Curr Neurol Neurosci Rep. 2014; 14(11):494. DOI: 10.1007/s11910-014-0494-0. View

18.

Wakai A, McCabe A, Roberts I, Schierhout G . Mannitol for acute traumatic brain injury. Cochrane Database Syst Rev. 2013; (8):CD001049. PMC: 7050611. DOI: 10.1002/14651858.CD001049.pub5. View

19.

James H, Langfitt T, Kumar V, Ghostine S . Treatment of intracranial hypertension. Analysis of 105 consecutive, continuous recordings of intracranial pressure. Acta Neurochir (Wien). 1977; 36(3-4):189-200. DOI: 10.1007/BF01405391. View

20.

Nwachuku E, Puccio A, Fetzick A, Scruggs B, Chang Y, Shutter L . Intermittent versus continuous cerebrospinal fluid drainage management in adult severe traumatic brain injury: assessment of intracranial pressure burden. Neurocrit Care. 2013; 20(1):49-53. DOI: 10.1007/s12028-013-9885-3. View