Acute Cerebrovascular Conditions · European Guidelines · Haemodynamics · Osmotherapy · Subarachnoid Haemorrhage · Traumatic Brain Injury

Fluid Therapy in Neurointensive Care patients – An ESICM Recommendation

Just published: the European Society of Intensive Care Medicine´s consensus document on fluid administration in the NICU. It covers all manner of neurocritical conditions and sums up the available evidence for various fluid therapy approaches. As expected there are few recommendations that aren´t already well established and by now fairly uncontroversial (multimodal monitoring, avoiding colloids,… Continue reading Fluid Therapy in Neurointensive Care patients – An ESICM Recommendation

Haemodynamics · Neurocritical Care · Neurotrauma · Traumatic Brain Injury

Another Trial Suggesting Beta-blockers Are Beneficial in TBI: Time for an RCT!

We covered the subject of beta-blockade in traumatic brain injury last autumn in this article, where we summarised the increasing evidence that it seems to improve survival. A recently published trial (free full text) in the Journal of Trauma and Acute Care Surgery adds further credence to the role of beta-blockers in this patient group. This… Continue reading Another Trial Suggesting Beta-blockers Are Beneficial in TBI: Time for an RCT!

Basic Sciences & Physiology · Haemodynamics · ICP/CPP management · Neurocritical Care · Neuromonitoring · Traumatic Brain Injury

Cerebral Autoregulation – What do we know?

We all recall the elegant curves that ostensibly show the neat relationship between mean  arterial blood pressure (or CPP) and cerebral blood flow. This relationship classically has its lower and upper limits, beyond which CBF will vary passively with the systemic pressure. Stay within these limits and all is good, the mantra goes. However, as… Continue reading Cerebral Autoregulation – What do we know?

Cardiovascular Conditions · Haemodynamics · Systemic Effects of CNS Pathology · Traumatic Brain Injury

Beta-blockers and TBI

This is a subject that has been on our backburner for a while and it’s now due for a discussion on neuroscand.com. The use of beta-blockers in traumatic brain injury is nothing new. The indications have been largely centered on targeting and preventing paroxysmal sympathetic hyperactivity (PSH) and associated post-TBI autonomic phenomena. Please see our… Continue reading Beta-blockers and TBI

Cardiovascular Conditions · Haemodynamics · Neurotrauma · Systemic Effects of CNS Pathology · Traumatic Brain Injury

Lancet: Paroxysmal Sympathetic Hyperactivity after TBI – An Underrecognized Clinical Entity

We have probably all struggled with these phenomena in our TBI patients in the neuro ICU: swinging blood pressures, episodic tachycardia and fever, occurring even several weeks after the initial traumatic event. In this article in the Lancet, Meyfroidt and colleagues offer us some insight into the clinical syndrome now known as paroxysmal sympathetic hyperreactivity.… Continue reading Lancet: Paroxysmal Sympathetic Hyperactivity after TBI – An Underrecognized Clinical Entity

Haemodynamics · TBI General · Traumatic Brain Injury

Prehospital BP and Mortality in TBI: Time to Reevaluate Our Haemodynamic Targets?

It is widely accepted that hypotension in patients with traumatic brain injury is associated with poorer outcomes, as confirmed in a number of studies. But is there really a reliable cut-off for when we should be happy with a TBI patient´s blood pressure in a prehospital setting? A recent article in JAMA Surgery (Spaite et… Continue reading Prehospital BP and Mortality in TBI: Time to Reevaluate Our Haemodynamic Targets?