domingo, 28 de diciembre de 2014

Trauma craneoencefálico/Head injury patients

Tratamiento prehospitalario inicial en trauma de cráneo. Actualización 

Pre-hospital and initial management of head injury patients: An update.
Chowdhury T1, Kowalski S1, Arabi Y2, Dash HH3.
Saudi J Anaesth. 2014 Jan;8(1):114-20. doi: 10.4103/1658-354X.125971.
BACKGROUND:Most of the bad outcomes in patients with severe traumatic brain injury (TBI) are related to the presence of a high incidence of pre-hospital secondary brain insults. Therefore, knowledge of these variables and timely management of the disease at the pre-hospital period can significantly improve the outcome and decrease the mortality. The Brain Trauma Foundation guideline on "Prehospital Management" published in 2008 could provide the standardized protocols for the management of patients with TBI; however, this guideline has included the relevant papers up to 2006. METHODS: A PubMed search for relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic, was conducted. RESULTS: Based on the evidence, majority of the management strategies comprise of rapid correction of hypoxemia and hypotension, the two most important predictors for mortality. However, there is still a need to define the goals for the management of hypotension and inclusion of newer difficultairway carts as well as proper monitoring devices for ensuring better intubation and ventilatory management. Isotonic saline should be used as the first choice for fluid resuscitation. The pre-hospital hypothermia has more adverse effects; therefore, this should be avoided. CONCLUSION: Most of the management trials published after 2007 have focused mainly on the treatment as well as the prevention strategies for secondary brain injury. The results of these trials would be certainly adopted by new standardized guidelines and therefore may have a substantial impact on the pre-hospital management in patients with TBI.
KEYWORDS: Evidence; pre-hospital management; secondary brain injury; traumatic brain injury;year=2014;volume=8;issue=1;spage=114;epage=120;aulast=Chowdhury;type=2

Manejo de la hipertensión intracraneal en los niños con trauma cerebral

Management of raised intracranial pressure in children with traumatic brain injury
Kukreti V, Mohseni-Bod H, Drake J..
J Pediatr Neurosci [serial online] 2014 [cited 2014 Dec 23];9:207-15.
Increased intracranial pressure (ICP) is associated with worse outcome after traumatic brain injury (TBI). The current guidelines and management strategies are aimed at maintaining adequate cerebral perfusion pressure and treating elevated ICP. Despite controversies, ICP monitoring is important particularly after severe TBI to guide treatment and in developed countries is accepted as a standard of care. We provide a narrative review of the recent evidence for the use of ICP monitoring and management of ICP in pediatric TBI.
Keywords: Craniectomy, intracranial pressure, traumatic brain injury
brain injury.

Anestesiología y Medicina del Dolor

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