“Several recent, well performed studies suggest that hypotension may also be a major contributor to postoperative neurologic impairment in children.” Clebone. University of Chicago, USA. Current Opinion Anesthesiology, 2015 Oct. Read the abstract here.
Published in 2013, the joint CNS/AANS Guidelines for the first time discourage the use of steroids for traumatic spinal cord injury. This comes after a thorough review of existing evidence and a critical re-examination of the NASCIS-studies previously interpreted as favouring steroid use. “In summary, there is no consistent or compelling medical evidence of any… Continue reading Steroids and Spinal Cord Injury – Excerpts From the Joint CNS/AANS Guideline
Spinal cord injury guidelines issued jointly by the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS). Published in Neurosurgery 2013. Read the full guidelines 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
Well known and must-read paper on the use of steroid cover in TBI patients. It is by far the largest trial on this subject and still forms the basis for today’s recommendations that steroids not be used in this patient group. Published in the Lancet 2005. “The risk of death was higher in the corticosteroid… Continue reading CRASH Trial on Steroids and TBI
ProTECT III, the results of which were published alongside those of the SYNAPSE-trial in the December 25 2014 issue of NEJM, demonstrates no patient-important advantage conferred by the administration of progesterone (albeit very early in this particular study) to TBI patients. “This clinical trial did not show a benefit of progesterone over placebo in the… Continue reading ProTECT III -Progesterone in TBI, Another Step Towards Futility
A Clinical Trial of Progesterone for Severe Traumatic Brain Injury, by Brett E. Skolnick et al, 2014. New England Journal of Medicine. “Primary and secondary efficacy analyses showed no clinical benefit of progesterone in patients with severe TBI. These data stand in contrast to the robust preclinical data and results of early single-center trials that provided… Continue reading Progesterone in TBI, Results from the SYNAPSE-trial
Review by the Cochrane Injuries Group (2012, Junpeng et al) shows some promise concerning the use of progesterone in TBI. “Current clinical evidence from three small RCTs indicates progesterone may improve the neurologic outcome of patients suffering TBI. This evidence is still insufficient and further multicentre randomised controlled trials are required”
This Cochrane Review by Saxena et al from 2014 reveals a paucity of RCTs to support moderate therapeutic hypothermia in TBI patients. It remains a widely used modality in spite of this absence of evidence. “In order to further explore the preliminary findings provided by animal models and observational clinical studies that suggests there may… Continue reading Cochrane Review – Modest cooling therapies (35ºC to 37.5ºC) for traumatic brain injury
The latest version of a Cochrane review of barbiturate therapy for ICP-management. “There is no evidence that barbiturate therapy in patients with acute severe head injury improves outcome. Barbiturate therapy results in a fall in blood pressure in one in four patients. This hypotensive effect will offset any ICP lowering effect on cerebral perfusion pressure”… Continue reading Cochrane Review – Barbiturates for acute traumatic brain injury
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