Blunt cerebrovascular injury is a relatively common finding in the traumatised patient and poses a number of clinical challenges. A Scandinavian group recently issued best practice guidelines for management of these injuries. You can find the article (free full-text) by Brommeland et al here.
This well-written article in Intensive Care Medicine nicely highlights the importance, and complexities, of the interaction between the brain and other organ systems in the setting of acute injury.
These guidelines were updated in 2018 and can be found here. Of special interest is the reversal of the recommendation to avoid general anaesthesia for thrombectomy in stroke, in view of newer data. The choice of conscious sedation versus GA should be individualised and are both approaches are acceptable, according to the revised guidelines. More on… Continue reading AHA/ASA Guidelines for Early Management of Patients with Acute Ischaemic Stroke
Lactate is well-known as an important energy substrate for brain tissue and plays a key role in neuroenergetics. Experimental data have shown that exogenous lactate administration may improve metabolism in injured brain cells, and possibly has neuroprotective properties. Till now there has been a paucity of human clinical studies on this subject. Carteron et al… Continue reading Lactate Improves Cerebral Perfusion After Acute Brain Injury – Recent Clinical Trial in Crit Care Med
Meyfroidt and colleagues recently published a commentary in Intensive Care Medicine addressing ten tenets in neurocritical care that merit debate. The article deals with the following ten statements: 1. Only neurointensivists should care about the brain. 2. Clinical examination of neurocritically ill patients is impossible. 3. We should no longer monitor ICP in traumatic brain… Continue reading Meyfroidt et al in ICM: Ten false beliefs in neurocritical care
Tranexamic acid (TXA) has been held as something of a wonder drug. It’s cheap, largely demonstrated to be safe and has been given a role in a number of settings. The 2013 CRASH-2 trial showed improved survival in trauma with bleeding, and thus became one of the most widely cited publications in traumatology and emergency medicine. Several… Continue reading TICH-2: No Benefit From TXA in ICH. What Now?
Excellent and widely read overview of sedation regimes in acute brain injury. Find the article by Oddo et al in Critical Care here.