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
Immediate apnea after acute head trauma is a concept that has received renewed focus lately. BIA/IBA (Brain Impact Apnea or as some call it, Impact Brain Apnea) was described in animal models as far back as 1874 by Koch and Filehne (1). A number of subsequent studies (2-5) have established a clear link between severity of impact and duration of… Continue reading Brain Impact Apnea
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
Excellent talk by Manoj Saxena on traumatic brain injury and temperature control. A useful overview of the available evidence. From SMACC Chicago 2015.
Life in The Fast Lane´s take on the use of ketamine in traumatic brain injury. Nice summary of available literature. Sums it up succinctly for those who are still reluctant to use ketamine in this patient group. For more on the same subject, see this article on ketamine and ICP.
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.
Retrospective cohort study by Patanwala and colleagues including 233 head injured patients that required RSI with either rocuronium or suxamethonium. The results reveal that sux was associated with increased mortality in the most severely injured subset, compared with roc. In patients with less severe injury there was no significant difference between the two NMBs. Interesting… Continue reading Roc or Sux in RSI of TBI Patients?
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)
We can use ketamine in patients with traumatic brain injury… The ketamine effect on ICP in traumatic brain injury. Zeiler et al, Canada. Neurocritical Care, 2014 Aug. Access the abstract here.
The most updated review by the Cochrane Collaboration on steroid use and traumatic brain injury. The vast majority of patients stem from the CRASH trial. “In the absence of a meta-analysis, we feel most weight should be placed on the result of the largest trial. The increase in mortality with steroids in this trial suggest… Continue reading Cochrane Review – Steroids and TBI