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
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?
An Evidence-Based Consensus Statement from the Neurocritical Care Society. Read more here. Best regards, Riikka Takala.
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
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”
In this commentary in Critical Care 2012 Dr. Nicholas Marko argues in favour of choosing HS over mannitol in management of intracranial hypertension.
Well written overview of ICP-management and the role of hyperosmolar therapy. By Ropper, 2014. The chapter comparing hypertonic saline and mannitol is particularly interesting.
“…treatment with mannitol may increase the likelihood of death when compared to treatment with hypertonic saline.” Read the Cochrane review from 2013: Mannitol for acute traumatic brain injury.
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
Listen to the podcast here. More about TBI and end tidal carbon dioxide/ PaCO2. Normocapnia and hyperventilation. Adjust the ventilation until end tidal CO2 is 4,7, then take an ABG… Use mannitol and “the patients will pee like race horses…”