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2008, Number 2

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Rev Mex Anest 2008; 31 (2)

Perioperative management of the patient with head injury

Cruz-Santos J, Cuenca-Dardón JF

Language: Spanish
References: 42
Page: 108-115
PDF size: 114.75 Kb.


ABSTRACT

Objective: To review the current recommendations involved in the management of traumatic brain injury. Material and methods: To review in ovid data bases all the articles related with the management of traumatic brain injury between march of 2001 to march of 2006. Results: The traumatic brain injury has incidence of 2% in the world population, and is the principal cause of death and severe disability in young population. Represent the 26% of all the patient with multiple injuries. 75% of all the patients that died presented ischemic lesions. The incidence of intracranial hypertension in severed head injuries is above 53 a 63% with abnormal CT scan, and 13% with normal study. The time of the patient in the Emergency Room should be less than 10 minutes. The time employed in the first evaluation should be performed in 120 seconds. The cardiopulmonary resuscitation algorithm: A: airway control with stabilized of cervical spine. All patient with severe head injury and Glasgow coma scale ‹ 8 should be intubated. A rapid sequence intubation is recommended to avoid increases in intracranial pressure. B: breathing: a «low» normocapnia is recommended, maintain PaCO2 between 4 to 4.5 kPas. The hyperventilation to low levels is associated with worst prognosis. Meanwhile the PaO2 should be › 13 kPas. C: circulation, is maintained above 90 mm Hg with fluids and inotropics. The principal objective is to keep the euvolemia. The permissive hypotension is not indicated in severe head trauma. D: neurologic deficit, evaluating the pain response and the unconsciousness state. Exposure: to search other lesions. The following of these recommendations is associated with better outcomes, and can not be substituted for sophisticated therapies in critical care. The platinum 10 minutes and golden hour concepts are still valid in the management of these patients. The intracranial hypertension and diffuse axonal lesions are the principal causes of death in patients with severe head injury. Conclusions: The traumatic brain injury is one of the principal causes of death and disability in population in productive age. The injury mechanism and the following of the principles of reanimation are related with the outcome and good prognosis in patients with severe head injury.


REFERENCES

  1. Domínguez RJM, Barrera CJM, García AC. Actualización en el manejo terapéutico del paciente con traumatismo craneoencefálico. Update en Medicina Intensiva, Ed. Ars Médica 2005;15: 217-235.

  2. Thurman D, Graus JF, Romer C. Standards for surveillance of neurotrauma, World Health Organization safety promotion and injury control. Division of emergency and humanitarian action. Geneva Switzerland 1995:1-41.

  3. Bullock R, Chesnut R, Ghajar J, et al. Management of TBI Author Group. Neurosurgery 2006;58:S2-3.

  4. Suleiman GH. Trauma Craneoncefálico Severo: parte I. Medicrit 2005;2:107-148.

  5. Aldrich EF, Eisenberg HM, Saydjari C, et al. Predictors of mortality in severily head- injured with civilian gunshot wound: a report from the NIH Traumatic coma Data Bank. Surg Neurol 1992;38:418-23.

  6. Guidelines for the Management of Penetrating Brain Injury. Introduction and Methodology. J Trauma 2001;51:S3-6.

  7. McPherson BC, McPherson P, Jennett B. Evidence of intracranial contusion and haematoma in relation to the site and type of skull fracture. Clin Radiol 1990;42:321-6.

  8. Guha A. Prehospital care of trauma must be improved in UK. BMJ 2001;323:1070.

  9. Muizelaar JP, Marmarou A, Ward JD, et al. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg 1991;75:731-9.

  10. Guha A. Management of traumatic brain injury: some current evidence and applications. Postgrad Med J 2004;80:650-653.

  11. Helm M, Schuster R, Hauke J, et al. Tight control of prehospital ventilation by capnography in major trauma victims. Br. J Anaesth 2003;90:327-32.

  12. Marmarou A. Anderson RL, Ward JD, et al. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 1991;75:S59-66.

  13. Vincent JL, Berré J. Primer on medical management of severe brain injury. Crit Care Med 2005;33:1392-1399.

  14. Verweij BH, Muiselaar JP, Vinas FC, et al. Impaired cerebral mitochondrial function after traumatic brain injury in humans. J Neurosurg 2000;93:815-820.

  15. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: A severity of the disease classification system. Crit Care Med 1985;13:1818-1829.

  16. Newberg AB, Alavi A. Neuroimaging in patients with head injury. Semin Nucl Med 2003;33:136-147.

  17. Maas AIR, Hukkelhoven CWPM, Marshall LF. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: A comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurg 2005;57:1173-1182.

  18. Poca MA. Actualizaciones en la fisiopatología y tratamiento de los pacientes con traumatismo craneoencefálico. Sociedad catalana de Anestesiología, Reanimación y Tratamiento del Dolor 2004:1-11.

  19. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Indications for intracranial pressure monitoring. J. Neurotrauma 2000;17:479-491.

  20. Rebuck JA, Murry KR, Rhoney DH, et al. Infection related to intracranial pressure monitors in adults: Analysis of risk factors and antibiotic prophylaxis. J Neurol Neurosurg Psychiatry 2000;69:381-384.

  21. Imberti R, Bellinzona G, Langer; Cerebral tissue PO2 and SjvO2 during moderate hyperventilation in patients with severe traumatic brain injury. J Neurosurg 2002;96:97-102.

  22. Weil MH, Shubin H. The VIP approach to the bedside management of shock. JAMA 1969;207:337-340.

  23. Marion DW, Puccio A, Wisniewski SR, et al. Effect of hyperventilation on extracellular concentrations of glutamate, lactate, pyruvate and local cerebral blood flowin patients with severe traumatic brain injury. Crit Care Med 2002;30:2619-2625.

  24. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Hyperventilation. J Neurotrauma 2000;17:513-520.

  25. Stocchetti N, Furlan A, Volta F. Hypoxemia and arterial hypotension at the accident scene in head injury. J Trauma 1996;40:764-767.

  26. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Resuscitation of blood pressure and oxigenation J Neurotrauma 2000;17:471-478.

  27. Steiner LA, Johnston AJ, Czonosyka M, et al. Direct comparison of cerebrovascular effects of norepinephrine and dopamine in head injured patients. Crit Care Med 2004;32:1049-1054.

  28. NG I, Lim J, Wong HB. Effects of head posture on cerebral hemodynamics: Its influences on intracranial pressure, cerebral perfusion pressure and cerebral oxygenation.

  29. Moraine JJ, Berre J, Melot C. Is cerebral perfusion a major determinant of cerebral blood flow during head elevation in comatose patients with severe intracranial lesions? J Neurosurg 2000;92: 606-614.

  30. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Critical Pathway for the treatment of established intracranial hypertension Hyperventilation. J Neurotrauma 2000;17:537-538.

  31. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Use of mannitol. J Neurotrauma 2000;17:521-525.

  32. Cruz J, Minoja G. Okuchi K, et al. Successful use of the new high-dose mannitol treatment in patients with Glasgow Coma Scores of 3 and bilateral abnormal papillary widening: a randomized trial. J Neurosurg 2004;100:376-383.

  33. Munar F, Ferer AM, de Nadal M, et al. Cerebral hemodynamic effects of 7.2% hypertonic saline, in patients with head injury an raised intracranial pressure. J Neurotrauma 2000;17:41-51.

  34. Dutton RP, McCunn M. Traumatic brain injury. Curr Opin Crit Care 2003;9:503-509.

  35. Oertel M, Kelly DF, Lee JH, et al. Efficacy of hyperventilation, blood pressure elevation and metabolic suppression therapy in controlling intracranial pressure after head injury. J Neurosurg 2002;97:1045-1053.

  36. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Role of antiseizure prophylaxis following head injury. J Neurotrauma 2000;17:549-553.

  37. Blackman JA, Patrick PD, Buck ML, et al. Paroxysmal autonomic instability with dystonia after brain injury. Arch Neurol 2004;61:321-328.

  38. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Nutrition. J Neurotrauma 2000;17:539-547.

  39. Kim J, Gearhart MM, Zurick A, et al. Preliminary report of the safety of heparin for deep venous thrombosis prophylaxis after severe head injury. J Trauma 2002;53:38-42.

  40. Dellinger RP, Carlet JM, Masur H, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858-873.

  41. Stocchetti N, Rossi S, Zanier ER, et al. Pyrexia in head-injured patients admitted to intensive care. Intensive Care Med 2002;28:1555-1562.

  42. Yates RI, Sandercock P, et al. Effect of intravenous corticosteroids on death within 14 days in 10,009 adults with clinically significant head injury (MCR CRASH trial) randomized placebo-controlled trial. Lancet 2004;364:1321-1328.




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