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Current needs, the future of adolescents and young adults having sustained a moderate or severe Traumatic Brain Injury (TBI) and the potential of their social participation  [PDF]
Sirois Katia, Boucher Normand, Lepage Céline
Open Journal of Therapy and Rehabilitation (OJTR) , 2014, DOI: 10.4236/ojtr.2014.21009
Abstract: The general objective of this study is to identify the specific needs of youths who have suffered a moderate or severe traumatic brain injury (TBI) and their levels of life habit accomplishments. The secondary objective aims to identify how they view themselves in the future with regard to their life habits. Eighteen young persons with moderate or severe TBIs aged 14 to 20 completed questionnaires based on the Life-Habits questionnaire and elaborated on their current level of satisfaction and their visions of the future. Teenagers reported that maintaining good interpersonal relationships, being autonomous, fulfilling their responsibilities, warding off lone-liness, as well as being supported in their efforts to reach a satisfying response to their needs and concerns were their highest priorities. In order to increase their satisfaction related to life habits they suggest improving external factors, such as information concerning TBIs to their entourage. They see themselves as complete social participants in the future. Youths with moderate or severe TBIs identified their needs and envisioned their future to be like that of any other teenager and young adult. They hope to start a family and find a good job. They also identified strategies to improve their life habits.
Is decompressive craniectomy useless in severe traumatic brain injury?
Junpeng Ma, Chao You, Lu Ma, Siqing Huang
Critical Care , 2011, DOI: 10.1186/cc10358
Abstract: Decompressive craniectomy (DC) is a straightforward procedure that for more than a century has been widely used to treat medically refractory intracranial hypertension of patients with severe traumatic brain injury (TBI). Although a series of clinical studies demonstrated that the procedure is the one of the most effective treatments in reducing intracranial pressure (ICP) [1,2], no large prospective randomized controlled trial (RCT) had investigated the relation between successful or sustained reduction of increased ICP and functional out-comes after DC. An updated Cochrane review published in 2009 identified only one prospective randomized clinical trial (n = 27 participants) that evaluated the effect of DC in severe TBI [3]. The same year, a small (n = 74 patients) RCT that was published by Qiu and colleagues [4] indicated the beneficial effects of DC in patients with acute post-traumatic brain swelling.In March of this year, a multicenter RCT by Cooper and colleagues [5] was published in the New England journal of Medicine. Before this multicenter RCT, a pilot randomized trial [6] was completed to enable the multicenter DC study protocol. This multicenter RCT enrolled 155 adults with severe non-penetrating TBI and medically refractory intracranial hypertension from December 2002 through April 2010 but excluded patients with mass lesions. The results showed that, although DC can immediately and constantly reduce ICP (mean ICP of 14.4 mm Hg versus 19.1 mm Hg; P < 0.001), the craniectomy group that received bifrontotemporoparietal DC (n = 73) may be associated with a worse functional out-come than the standard-care group (n = 82) (odds ratio of 1.84 and 95% confidence interval of 1.05 to 3.24; P = 0.03). As this trial is well planned and of high quality, the unexpected result is meaningful and should be considered a reference for an evidence-based guideline. However, the evidence of the study is insufficient. First, the relatively small sample size is inadequate to
Effect of Posttraumatic Serum Thyroid Hormone Levels on Severity and Mortality of Patients with Severe Traumatic Brain Injury
Babak Malekpour,Ali Mehrafshan,Forough Saki,Zahed Malekmohammadi
Acta Medica Iranica , 2012,
Abstract: Traumatic brain injury (TBI) is an important cause of death and disability in young adults ,and may lead to physical disabilities and long-term cognitive, behavioral psychological and social defects. There is a lack of definite result about the effect of thyroid hormones after traumatic brain injury in the severity and no data about their effect on mortality of the injury. The aim of this study is to evaluate the effect of thyroid hormones after traumatic brain injury in the severity and mortality and gain a clue in brain injury prognosis. In a longitudinal prospective study from February 2010 until February 2011, we checked serum levels of T3, T4, TSH and TBG of severely brain injured patients and compared the relationship of them with primary Glasgow Coma Scale (GCS) score and mortality of patients. Statistical analysis used SPSS 11.5 software with using chi-square and Fisher exact test. Serum levels of T3 and T4 were decreased after brain trauma but not TSH and TBG. Mortality rates were higher in patients with lower T4 serum levels. The head injury was more severe in whom with low T3 and T4. Follow a severe brain injury a secondary hypothyroidism is happened due to pituitary dysfunction. Also, serum level of T3 and T4 on the first day admission affect on primary GCS score of patients which is an indicator of severity of brain injury. In addition, mortality rates of severely brain injured patients have a high correlation with the serum level of T4 in the first day admission.
Vestibulo-ocular monitoring as a predictor of outcome after severe traumatic brain injury
Hans-Georg Schlosser, Jan-Nikolaus Lindemann, Peter Vajkoczy, Andrew H Clarke
Critical Care , 2009, DOI: 10.1186/cc8187
Abstract: Vestibulo-ocular monitoring is based on video-oculographic recording of eye movements during galvanic labyrinth polarization. The integrity of vestibulo-ocular reflex is determined from the eye movement response during vestibular galvanic labyrinth polarization stimulation. Vestibulo-ocular monitoring is performed within three days after traumatic brain injury and the oculomotor response compared to outcome after six months (Glasgow Outcome Score).Twenty-seven patients underwent vestibulo-ocular monitoring within three days after severe traumatic brain injury. One patient was excluded from the study. In 16 patients oculomotor response was induced, in the remaining 11 patients no oculomotor response was observed. The patients' outcome was classified as Glasgow Outcome Score 1-2 or as Glasgow Outcome Score 3 to 5. Statistical testing supported the hypothesis that those patients with oculomotor response tended to recover (exact two-sided Fisher-Test (P < 10-3)).The results indicate that vestibulo-ocular monitoring with galvanic labyrinth polarization performed during the first days after traumatic brain injury helps to predict favourable or unfavourable outcome. As an indicator of brainstem function, vestibulo-ocular monitoring provides a useful, complementary approach to the identification of brainstem lesions by imaging techniques.Severe traumatic brain injury (sTBI) is the most prevalent cause of mortality and severe morbidity in young adults in industrialized countries, for example, in Germany 30,000 people suffer from severe brain trauma each year. A total of 10,000 result in death, and a further 4,500 have a severe disabled outcome and require permanent care (Federal Statistic Office). At present, assessment of outcome in the acute phase of sTBI is difficult and the contributing elements are under discussion.One promising approach to improving this situation has been the examination of the brainstem using imaging techniques. This has permitted classification of t
Aquaporin 9 in rat brain after severe traumatic brain injury
Liu, Hui;Yang, Mei;Qiu, Guo-ping;Zhuo, Fei;Yu, Wei-hua;Sun, Shan-quan;Xiu, Yun;
Arquivos de Neuro-Psiquiatria , 2012, DOI: 10.1590/S0004-282X2012000300012
Abstract: objective: to reveal the expression and possible roles of aquaporin 9 (aqp9) in rat brain, after severe traumatic brain injury (tbi). methods: brain water content (bwc), tetrazolium chloride staining, evans blue staining, immunohistochemistry (ihc), immunofluorescence (if), western blot, and real-time polymerase chain reaction were used. results: the bwc reached the first and second (highest) peaks at 6 and 72 hours, and the blood brain barrier (bbb) was severely destroyed at six hours after the tbi. the worst brain ischemia occurred at 72 hours after tbi. widespread aqp9-positive astrocytes and neurons in the hypothalamus were detected by means of ihc and if after tbi. the abundance of aqp9 and its mrna increased after tbi and reached two peaks at 6 and 72 hours, respectively, after tbi. conclusions: increased aqp9 might contribute to clearance of excess water and lactate in the early stage of tbi. widespread aqp9-positive astrocytes might help lactate move into neurons and result in cellular brain edema in the later stage of tbi. aqp9-positive neurons suggest that aqp9 plays a role in energy balance after tbi.
Characteristics of Hemodynamic Disorders in Patients with Severe Traumatic Brain Injury  [PDF]
Ryta E. Rzheutskaya
Critical Care Research and Practice , 2012, DOI: 10.1155/2012/606179
Abstract: Purpose. To define specific features of central hemodynamic parameter changes in patients with isolated severe traumatic brain injury (STBI) and in patients with clinically established brain death and to determine the required course of treatment for their correction. Data and Research Methods. A close study of central hemodynamic parameters was undertaken. The study involved 13 patients with isolated STBI (group STBI) and 15 patients with isolated STBI and clinically established brain death (group STBI-BD). The parameters of central hemodynamics were researched applying transpulmonary thermodilution. Results. In the present study, various types of hemodynamic reaction (normodynamic, hyperdynamic, and hypodynamic) were identified in patients with isolated STBI in an acute period of traumatic disease. Hyperdynamic type of blood circulation was not observed in patients with isolated STBI and clinically established brain death. Detected hemodynamic disorders led to the correction of the ongoing therapy under the control of central hemodynamic parameters. Conclusions. Monitoring of parameters of central hemodynamics allows to detect the cause of disorders, to timely carry out the required correction, and to coordinate infusion, inotropic, and vasopressor therapy. 1. Introduction Pathophysiological changes arising after primary brain injury lead to the secondary brain injury [1–3]. Both prehospital and inhospital hypotensions have been shown to have a deleterious influence on outcome from severe traumatic brain injury (STBI) [2, 4–6]. The development of hypotension in patients with STBI can be caused by the reduction of systematic vascular resistance as a result of injury of diencephalic region, the increase of cerebral dislocation signs, and the development of adrenal insufficiency. Another reason for hypotension can be a drop of cardiac output due to the reduction of contractility or hypovolemia, which develops as a result of fluid loss during bleeding, dehydration therapy, diabetes insipidus, and hyperthermia. Hypovolemia initiates the centralization of blood circulation which subsequently brings a number of adverse effects, such as stasis and sludge of erythrocytes in capillaries, ischemia of organs and tissues, tissue edema, and multiple organ failure. Neurogenic Stunned Myocardium (NSM) is still another reason for hypotension, but it has rarely been reported in association with STBI [7]. The main purpose of the ongoing therapy is to prevent and correct hypotension (systolic blood pressure (SBP) < 90?mmHg) [4, 8, 9] and to maintain the target figures of
Impact of falls on early mortality from severe traumatic brain injury
Linda M Gerber, Quanhong Ni, Roger H?rtl, Jamshid Ghajar
Journal of Trauma Management & Outcomes , 2009, DOI: 10.1186/1752-2897-3-9
Abstract: After exclusion criteria were applied, a total of 2162 patients were eligible for analysis. Falls contributed to 21% of all severe TBI, 12% occurring from > 3 meters and 9% from < 3 meters. Two-week mortality ranged from 18% due to injuries other than falls to 31% due to falls from < 3 meters (p =< 0.0001). Mortality after a severe TBI is much greater among older people, reaching 58% for people 65 years and older sustaining a fall from < 3 meters.Among those 65 and older, falls contributed to 61% of all injuries and resulted in especially high mortality among individuals experiencing low falls. Preventive efforts directed toward older people to avoid falls from < 3 meters could have a significant impact on mortality.Traumatic brain injury (TBI) is the leading cause of death among ages 1 to 44 years. Each year in the United States there are 50,000 deaths from TBI and an additional 70,000 to 90,000 individuals are left with permanent neurological disabilities [1]. TBI is the leading cause of death among all trauma-related deaths [2,3].Since 2000, a quality improvement (QI) program exists in New York for tracking the treatment of severe TBI patients (Glasgow Coma Scale [GCS] score < 9) in 24 of the 46 state designated trauma centers. The program, initiated by the Brain Trauma Foundation and funded through the New York State Department of Health Bureau of Emergency Medical Services, is designed to assess and implement adoption of the evidence-based Guidelines for the Management of Severe Traumatic Brain Injury. The Guidelines were formulated and disseminated in 1995 [4] and updated in 2000 [5] and 2006 [6] by the Brain Trauma Foundation in collaboration with the American Association of Neurological Surgeons.Severe TBI results in prolonged hospital stays and is the most common cause of traumatic deaths [7,8]. Most severe TBIs are due to falls or motor vehicle-related incidents [9]. The populations at risk for the causes of injury vary by age and other demographic charact
Impact of non-neurological complications in severe traumatic brain injury outcome
Luisa Corral, Casimiro F Javierre, Josep L Ventura, Pilar Marcos, José I Herrero, Rafael Ma?ez
Critical Care , 2012, DOI: 10.1186/cc11243
Abstract: An observational retrospective cohort study was conducted in one multidisciplinary ICU of a university hospital (35 beds); 224 consecutive adult patients with severe TBI (initial Glasgow Coma Scale (GCS) < 9) admitted to the ICU were included. Neurological and non-neurological variables were recorded.Sepsis occurred in 75% of patients, respiratory infections in 68%, hypotension in 44%, severe respiratory failure (arterial oxygen pressure/oxygen inspired fraction ratio (PaO2/FiO2) < 200) in 41% and acute kidney injury (AKI) in 8%. The multivariate analysis showed that Glasgow Outcome Score (GOS) at one year was independently associated with age, initial GCS 3 to 5, worst Traumatic Coma Data Bank (TCDB) first computed tomography (CT) scan and the presence of intracranial hypertension but not AKI. Hospital mortality was independently associated with initial GSC 3 to 5, worst TCDB first CT scan, the presence of intracranial hypertension and AKI. The presence of AKI regardless of GCS multiplied risk of death 6.17 times (95% confidence interval (CI): 1.37 to 27.78) (P < 0.02), while ICU hypotension increased the risk of death in patients with initial scores of 3 to5 on the GCS 4.28 times (95% CI: 1.22 to15.07) (P < 0.05).Low initial GCS, worst first CT scan, intracranial hypertension and AKI determined hospital mortality in severe TBI patients. Besides the direct effect of low GCS on mortality, this neurological condition also is associated with ICU hypotension which increases hospital mortality among patients with severe TBI. These findings add to previous studies that showed that non-neurological complications increase the length of stay and morbidity in the ICU but do not increase mortality, with the exception of AKI and hypotension in low GCS (3 to 5).Severe Traumatic Brain Injury (TBI) mortality and morbidity is frequently caused by the neurological consequences of the brain injury [1,2]. Nevertheless, non-neurological complications are also frequent, and may be card
Bromocriptine in Central Hyperthermia after Severe Traumatic Brain Injury  [PDF]
Tamer Zakhary, Ahmed Sabry
Open Journal of Emergency Medicine (OJEM) , 2017, DOI: 10.4236/ojem.2017.53010
Abstract: Strong evidence showed that fever after traumatic brain injury TBI is associated with increased mortality. In this study, we tried to evaluate the role of Bromocriptine in central hyperthermia in patients with severe TBI. This prospective controlled study was conducted on 50 severe TBI patients who admitted to the critical care department and confirmed on Computed Tomography (CT) of the brain and GCS of less than 9 at admission. Then, they were randomly assigned into 2 groups. Bromocriptine group (25) received bromocriptine 7.5 mg/day during 24 hours from admission through a naso-gastric (NG) feeding tube. Control group (25) received conventional treatment only. Temperature was measured every 2 hours. The antipyretic measures used were the same across all patients enrolled. The primary outcome was number of patients diagnosed with central hyperthermia. After the discharge of all patients, there was a statistically significant difference between the 2 groups in number of patients diagnosed with central hyperthermia (6 (24%) in bromocriptine group Vs 18 (72%) in control, p = 0.002). There were no differences in hospital length of stay (p = 0.904) or mortality (p = 0.393). Early administration of bromocriptine in severe TBI may be associated with lower incidence of central hyperthermia with no effect on length of stay or mortality.
The incidence and risk factors of ventilator-associated pneumonia in patients with severe traumatic brain injury
Marjanovi? Vesna,Novak Vesna,Veli?kovi? Ljubinka,Marjanovi? Goran
Medicinski Pregled , 2011, DOI: 10.2298/mpns1108403m
Abstract: Introduction. Patients with severe traumatic brain injury are at a risk of developing ventilator-associated pneumonia. The aim of this study was to describe the incidence, etiology, risk factors for development of ventilator- associated pneumonia and outcome in patients with severe traumatic brain injury. Material and Methods. A retrospective study was done in 72 patients with severe traumatic brain injury, who required mechanical ventilation for more than 48 hours. Results. Ventilator-associated pneumonia was found in 31 of 72 (43.06%) patients with severe traumatic brain injury. The risk factors for ventilator-associated pneumonia were: prolonged mechanical ventilation (12.42 vs 4.34 days, p<0.001), longer stay at intensive care unit (17 vs 5 days, p<0.001) and chest injury (51.61 vs 19.51%, p< 0.009) compared to patients without ventilator-associated pneumonia.. The mortality rate in the patients with ventilator-associated pneumonia was higher (38.71 vs 21.95%, p= 0.12). Conclusion. The development of ventilator-associated pneumonia in patients with severe traumatic brain injury led to the increased morbidity due to the prolonged mechanical ventilation, longer stay at intensive care unit and chest injury, but had no effect on mortality.
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