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…”
The full statement is available here: The Insertion and Management of External Ventricular Drains: An Evidence-Based Consensus Statement – A Statement for Healthcare Professionals from the Neurocritical Care Society. Published in Neurocritical Care 2016.
Intermittent versus continuous cerebrospinal fluid drainage management in adult severe traumatic brain injury: assessment of intracranial pressure burden. This small cohort study (n=62) from 2014 by Nwachuku EL suggests that continuous drainage is associated with better ICP-control. Read the abstract in Neurocritical Care.
An excellent talk by Shock Trauma’s eminent Thomas Scalea on ICP-management. Funny and insightful. I keep going back to this podcast from 2013 every now and then for a bit of inspiration.
“.. infusion of 2 ml kg(-1) during 20 min has a predictable and clinically significant beneficial effect on ICP and CPP.” Predictable reduction of intracranial hypertension with hypertonic saline hydroxyethyl starch: a prospective clinical trial in critically ill patients with subarachnoid hemorrhage. Bentsen et al, Norway. Acta Anaesthesiologica Scandinavica, 2004 Oct. Read the abstract here. Hypertonic… Continue reading SAH-patients: HyperHaes and reduction in ICP (2004)
Pressure-derived versus pressure wave amplitude-derived indices of cerebrovascular pressure reactivity in relation to early clinical state and 12-month outcome following aneurysmal subarachnoid haemorrhage. Abstract of original article by Eide et al. Published in the Journal of Neurosurgery 2012.
Routine intracranial pressure monitoring in acute coma (Cochrane 2015) A recent review of the available literature, pointing to the lack of sufficient evidence concerning the use of ICP monitoring in acute coma. Only one RCT has been conducted (see here) but this trial was questioned on the grounds of a disproportionally high mortality in both… Continue reading Cochrane review of routine ICP measurement in acute coma (2015)
“…PEEP has no significant effect on cerebral and systemic hemodynamics…” Interesting reading about the effects of peep ! Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance. Caricato et al, Italy. The Journal of Trauma, 2005 Mar. Abstract available here.
Published in 2013 this Cochrane Review of the Lund Concept for Severe Traumatic Brain Injury by Muzevic and Splavski could not find any high-grade evidence to support the practice associated with this concept. “There was no evidence from randomised controlled trials on the effe cts of the Lund concept in the management of severe traumatic brain injury. This treatment should not… Continue reading Cochrane Review – The Lund concept for severe traumatic brain injury