Management of moderate to severe traumatic brain injury: an update for the intensivist.

Autor: Meyfroidt G; Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium. geert.meyfroidt@kuleuven.be., Bouzat P; Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France., Casaer MP; Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium., Chesnut R; Department of Neurological Surgery, Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA., Hamada SR; Anaesthesia and Critical Care Department, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Université Paris Sud, 78 rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France., Helbok R; Department of Neurology, Neurocritical Care Unit, Innsbruck, Austria., Hutchinson P; Department of Academic Neurosurgery, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK., Maas AIR; Department of Neurosurgery, University Hospital Antwerp, Edegem, Belgium., Manley G; Brain and Spinal Injury Center, Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA., Menon DK; Department of Medicine, University Division of Anaesthesia, University of Cambridge, Cambridge, UK., Newcombe VFJ; Department of Medicine, University Division of Anaesthesia, University of Cambridge, Cambridge, UK., Oddo M; Faculty of Biology and Medicine, Université de Lausanne, Lausanne, Switzerland., Robba C; Anesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience and Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, University of Genoa, Genova, Italy., Shutter L; Critical Care Medicine, Neurology, and Neurosurgery, UPMC/University of Pittsburgh School of Medicine, Pittsburgh, Pensylvania, USA., Smith M; Neurocritical Care Unit, The National Hospital for Neurology and Neurosurgery, University College London Hospitals and National Institute for Health Research Biomedical Research Centre, London, UK., Steyerberg EW; Clinical Biostatistics and Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands., Stocchetti N; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Taccone FS; Department of Intensive Care, Université Libre de Bruxelles (ULB) and Laboratoire de Recherche Experimentale, Department of Intensive Care, Hôpital Erasme, Brussels, Belgium., Wilson L; Division of Psychology, University of Stirling, Stirling, UK., Zanier ER; Laboratory of Acute Brain Injury and Therapeutic Strategies, Dept of Neuroscience, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy., Citerio G; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.; Neurointensive Care Unit, San Gerardo Hospital, Monza, Italy.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2022 Jun; Vol. 48 (6), pp. 649-666. Date of Electronic Publication: 2022 May 20.
DOI: 10.1007/s00134-022-06702-4
Abstrakt: Traumatic brain injury (TBI) remains one of the most fatal and debilitating conditions in the world. Current clinical management in severe TBI patients is mainly concerned with reducing secondary insults and optimizing the balance between substrate delivery and consumption. Over the past decades, multimodality monitoring has become more widely available, and clinical management protocols have been published that recommend potential interventions to correct pathophysiological derangements. Even while evidence from randomized clinical trials is still lacking for many of the recommended interventions, these protocols and algorithms can be useful to define a clear standard of therapy where novel interventions can be added or be compared to. Over the past decade, more attention has been paid to holistic management, in which hemodynamic, respiratory, inflammatory or coagulation disturbances are detected and treated accordingly. Considerable variability with regards to the trajectories of recovery exists. Even while most of the recovery occurs in the first months after TBI, substantial changes may still occur in a later phase. Neuroprognostication is challenging in these patients, where a risk of self-fulfilling prophecies is a matter of concern. The present article provides a comprehensive and practical review of the current best practice in clinical management and long-term outcomes of moderate to severe TBI in adult patients admitted to the intensive care unit.
(© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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