Following the recent publication of a systematic review and meta-analysis by Al Lawati et al. on TXA in traumatic brain injury (showing no discernible benefit from TXA, yet suggesting no harm), the debate surrounding the findings of the CRASH-3 trial has been treated to another revival. In this editorial in Intensive Care Medicine Dr Andrew… Continue reading CRASH 3 Debate Continues – TXA in TBI: systematic review and meta-analysis trumps a large RCT? A Sobering Editorial by Maas et al.
This recently published open-access article by Robba et al delves into the retrospective monitoring data on 70 TBI patients. The patients in the cohort were all monitored comprehensively, providing the investigators with continuous data on PbtO2, ICP and CPP, as well as on relevant respiratory indices. They found a statistically significant link between lung function… Continue reading Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury – Retrospective Study
The first edition of this comprehensive guide to the treatment of severe TBI was originally published in 2012, based entirely on editorial contributions from Nordic researchers and clinicians. It has proven to be a very useful and popular reference tool for professionals working with TBI. After an extensive review of all the relevant topics, the… Continue reading Fresh off the Press: The Long Awaited 2nd Edition of Management of Severe Traumatic Brain Injury
The Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC) recently released a superb article detailing the recommended treatment approach in TBI-patients with both cerebral tissue oximetry and ICP-monitoring. It provides an easy-to-follow and logical multi-tier algorithm for addressing various combinations of ICP/PbtO2 abnormalities. As such it offers a guidance document for clinical care that… Continue reading SIBICC: Management Algorithm for TBI-patients with both PbtO2 and ICP-monitoring
In December 2019 the Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society and the Neuro Anaesthesia and Critical Care Society published their joint guidelines on how to safely transfer patients with acute brain injury to the appropriate level of care. Focusing on TBI and stroke-related brain injury, this consensus document outlines both… Continue reading Joint AAGBI & NACCS Guidelines on Safe Transfer of the Brain Injured Patient
The Society for Neuroscience in Anesthesiology and Critical Care (SNACC) incoming president Dr. Deepak Sharma shares his thoughts as we approach the new year. Some valuable input to bring with us into the holidays. Read his newsletter here.
This month’s edition of Current Opinion in Anaesthesiology is replete with neuro-topics, ranging from awake craniotomy to complex spinal surgery and anaesthesia for stroke thrombectomy. Well worth a read, this collection of articles provides (often excellent) summaries of evidence and current practice in numerous fields relevant to the neuroanaesthetist.
The optimal hyperosmotic agent for treatment of intracranial hypertension following TBI has been an inexhaustible subject of debate. Scant evidence underlies these discussions despite widespread and long-standing use of both agents. In this article Anstey et al. retrospectively analysed data from 14 different centres to compare outcomes in mannitol-only and hypertonic saline-only cohorts. They excluded… Continue reading Mannitol vs. Hypertonic Saline in TBI – A Retrospective Study
SNACC’s article of the month for July is an excellent narrative review on the pharmacodynamics of vasopressors in health and in the setting of brain injury. The review is preceded by an introductory commentary by neuroscand.com contributor Dr. Riikka Takala.
The landmark 2016 ATACH II trial compared aggressive blood pressure lowering (110-139 mmHg) with standard BP-targets (140-180) in patients with spontaneous ICH, and found no difference between the groups. The main endpoints were mortality and functional neurological outcome (modified Rankin scale). The only discernible difference was a tendency towards less haematoma expansion in the intervention… Continue reading ATACH II Follow-up Subgroup Analysis: Intensive BP Reduction Reduces Expansion of Deep ICH, But No Difference in Functional Outcome