Fluid Management · Haemodynamics · Osmotherapy · Subarachnoid Haemorrhage · TBI General

Critical Care: Fluid Therapy in Neurological Patients

Right off the press: an open access review article from Critical Care on fluid therapy in the neurological patient. It provides a nice synopsis of the different fluid therapy paradigms that are advocated through various guidelines. The review challenges some of the tenets of basic treatment, such as empirical fluid maintenance and the definition of… Continue reading Critical Care: Fluid Therapy in Neurological Patients

Acute Cerebrovascular Conditions · Haemodynamics · ICP/CPP management · Intracerebral Haemorrhage

Best BETs – Safe to Lower BP in ICH?

A quick review published in BMJ´s Best Evidence Topic Reports series, April 2016 by Kapil Mohan Rajwani and Azlisham Mohd Nor. They address the issue of lowering elevated blood pressures in patients with an acute ICH. Is it safe and is there evidence to support active BP-management? And if yes, what´s our target? Targeted blood pressure management in… Continue reading Best BETs – Safe to Lower BP in ICH?

ICP/CPP management · Neuromonitoring · TBI General · Traumatic Brain Injury

BEST TRIP – ICP vs. CT/clinical exam for TBI

Now more than three years old, but still an absolute landmark study and mandatory reading for anyone who cares for neurotrauma patients. Smallish trial but very well carried out and yielding some remarkable findings. A commonly cited article by Randy Chesnut and his group showing equipoise between an ICP-driven protocol and management determined by CT… Continue reading BEST TRIP – ICP vs. CT/clinical exam for TBI

ICP/CPP management · Intracranial Surgery General · Osmotherapy

Cochrane Review – Mannitol vs. HS in Patients Undergoing Craniotomy

Cochrane review from 2014: Mannitol versus hypertonic saline for brain relaxation in patients undergoing craniotomy. By Prabhakar et al.   “From the limited data available on the use of mannitol and hypertonic saline for brain relaxation during craniotomy, it is suggested that hypertonic saline significantly reduces the risk of tense brain during craniotomy”

Intracerebral Haemorrhage · Surgical Measures · Traumatic Brain Injury

The Bottom Line – The STITCH Trial

The excellent reviewers at The Bottom Line are taking a thorough look at the STITCH (Trauma) trial of 2015. The STITCH (Trauma) trial (Early Surgery versus Initial Conservative Treatment in Patients with Traumatic Intracerebral Hemorrhage) recruited 170 patients into a multicenter RCT to determine whether early surgery (within 12 hours) for traumatic intracerebral haemorrhage would confer a mortality benefit… Continue reading The Bottom Line – The STITCH Trial