In this interesting trial by Lima and colleagues, with findings published recently in the Journal of Neurosurgical Anesthesiology, the authors compare normal saline (NS) with a balanced crystalloid as a maintenance fluid for elective tumour resection in paediatric patients. Their main endpoint was change in serum chloride from baseline to end of surgery. Perhaps unsurprisingly… Continue reading Balanced Crystalloids Better Than Isotonic Saline for Craniotomy in Kids?
Endovascular thrombectomy is a cornerstone of ischaemic stroke managament. Time from stroke to intervention has been clearly linked to functional outcome (1) and is a key metric to which much attention is devoted. But what about the duration of the procedure itself? Earlier data has suggested that length of procedure may affect functional outcomes after… Continue reading Recent study in JACC – Procedure Time in Stroke Thrombectomies Has Impact on Outcomes
In a long overdue update, the Brain Trauma Foundation have issued their recently revised guidelines for management of paediatric severe traumatic brain injury. We at neuroscand.com have yet to assess all of the recommendations yet, so expect more as we get through the whole document. At first glance, though, there seems to be little substantial… Continue reading BTF Guidelines for Paediatric TBI 2019 – Finally Updated
This study, recently published in JAMA, revealed no beneficial effect from hypothermia as an adjunct to decompressive hemicraniectomy in the setting of middle cerebral artery stroke. In fact, the authors’ findings even suggest harm. Find the article here.
Hermanides and colleagues recently reviewed all available evidence on blood glucose targets in the TBI patient. Read their finding in this article in Critical Care. When comparing strict glycaemic regimens with more liberal strategies they found no significant differences in patient-important outcomes, contrary to earlier findings. They did reveal an increased risk of hypoglycaemia, however.… Continue reading Glycaemic Control Targets After Traumatic Brain Injury: A Systematic Review and Meta-analysis
Blunt cerebrovascular injury is a relatively common finding in the traumatised patient and poses a number of clinical challenges. A Scandinavian group recently issued best practice guidelines for management of these injuries. You can find the article (free full-text) by Brommeland et al here.
This well-written article in Intensive Care Medicine nicely highlights the importance, and complexities, of the interaction between the brain and other organ systems in the setting of acute injury.
A very worthwhile excerpt on TBI from the Cambridge Handbook of Clinical Neurology, written by Menon and Ercole. Summarises current thinking on neurointensive care of TBI patients. Read it here.
These guidelines were updated in 2018 and can be found here. Of special interest is the reversal of the recommendation to avoid general anaesthesia for thrombectomy in stroke, in view of newer data. The choice of conscious sedation versus GA should be individualised and are both approaches are acceptable, according to the revised guidelines. More on… Continue reading AHA/ASA Guidelines for Early Management of Patients with Acute Ischaemic Stroke
POLAR RCT is probably the most anticipated neurotrauma trial of the year and its findings were finally presented at this year’s ESICM congress in Paris. Before I comment on what POLAR RCT is all about, it’s worth taking some time to consider what this trial is NOT about. It does not deal specifically with TBI… Continue reading POLAR RCT – Don’t Worry, Thermoregulation Isn’t Dead Quite Yet