There has been a recent important update to the Brain Trauma Foundation guidelines regarding decompressive craniectomy for intractable intracranial hypertension, published in Neurosurgery. The latest iteration of the BTF guidelines from 2016 was released prior to the publication of the RESCUEicp study, as well as the 12 month outcome data from the DECRA trial. With… Continue reading BTF guidelines – Decompressive Craniectomy Update
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
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
From our quality-focused colleagues at the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) comes this set of guidelines for management of the most common emergencies encountered in neuroanaesthetic practice. Conceived with the purpose of addressing complex emergent issues in a concise, goal-directed and simplified manner, these cognitive aids are clear-cut and based on… Continue reading SNACC – How to Handle Neuroanaesthetic Emergencies
In this interesting trial by Lima and colleagues, with findings published recently in the Journal of Neurosurgical Anesthesiology, the authors compare normal saline (NS) with a balanced crystalloid as a maintenance fluid for elective tumour resection in paediatric patients. Their main endpoint was change in serum chloride from baseline to end of surgery. Perhaps unsurprisingly… Continue reading Balanced Crystalloids Better Than Isotonic Saline for Craniotomy in Kids?
POLAR RCT is probably the most anticipated neurotrauma trial of the year and its findings were finally presented at this year’s ESICM congress in Paris. Before I comment on what POLAR RCT is all about, it’s worth taking some time to consider what this trial is NOT about. It does not deal specifically with TBI… Continue reading POLAR RCT – Don’t Worry, Thermoregulation Isn’t Dead Quite Yet
I came across this useful little review in Kidney International Reports covering a subject I always find difficult to grasp: sodium disturbances and their influence on the brain. The article delves into the matter in a concise and understandable way, making it just about manageable even for an anaesthetist.
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
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?
After completing recruitment of some 408 TBI patients in 2014, the RESCUEicp group finally published the results from this eagerly awaited trial. The article by Hutchinson et al, titled Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension, was published on September 7th in the New England Journal of Medicine. So let´s go straight to the core: The study… Continue reading RESCUEicp Trial Results Finally Out: Craniectomy in TBI Lowers Mortality, But Survivors Suffer Worse Neurological Outcomes