| Title |
Refractory intracranial hypertension and “second-tier” therapies in traumatic brain injury
|
|---|---|
| Published in |
Intensive Care Medicine, December 2007
|
| DOI | 10.1007/s00134-007-0948-9 |
| Pubmed ID | |
| Authors |
Nino Stocchetti, Clelia Zanaboni, Angelo Colombo, Giuseppe Citerio, Luigi Beretta, Laura Ghisoni, Elisa Roncati Zanier, Katia Canavesi |
| Abstract |
To quantify the occurrence of high intracranial pressure (HICP) refractory to conventional medical therapy after traumatic brain injury (TBI) and to describe the use of more aggressive therapies (profound hyperventilation, barbiturates, decompressive craniectomy). Prospective study of 407 consecutive TBI patients Three neurosurgical intensive care units (ICU). Intracranial pressure (ICP) was studied during the first week after TBI; 153 patients had at least 1 day of ICP>20 mmHg. Early surgery was necessary for 221 cases, and standard medical therapy [sedation, mannitol, cerebrospinal fluid (CSF) withdrawal, PaCO2 30-35 mmHg] was used in 135 patients. Reinforced treatment (PaCO2 25-29 mmHg, induced arterial hypertension, muscle relaxants) was used in 179 cases (44%), and second-tier therapies in 80 (20%). Surgical decompression and/or barbiturates were used in 28 of 407 cases (7%). Six-month outcome was recorded in 367 cases using the Glasgow outcome scale (GOS). The outcome was favorable (good recovery or moderate disability) in 195 cases (53%) and unfavorable (all the other categories) in 172 (47%). HICP was associated with worse outcome. Outcome for cases who had received second-tier therapies was significantly worse (43% favorable at 6 months, p=0.03). HICP is frequent and is associated with worse outcome. ICP was controlled by early surgery and first-tier therapies in the majority of cases. Profound hyperventilation, surgical decompression and barbiturates were used in various combinations in a minority of cases. The indications for surgical decompression and/or barbiturates seem restricted to less than 10% of severe TBI. |
X Demographics
The data shown below were collected from the profiles of 2 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Australia | 2 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 50% |
| Scientists | 1 | 50% |
Mendeley readers
The data shown below were compiled from readership statistics for 146 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Brazil | 3 | 2% |
| Italy | 1 | <1% |
| Chile | 1 | <1% |
| Belgium | 1 | <1% |
| Spain | 1 | <1% |
| Unknown | 139 | 95% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 21 | 14% |
| Student > Postgraduate | 19 | 13% |
| Researcher | 17 | 12% |
| Student > Master | 12 | 8% |
| Student > Bachelor | 11 | 8% |
| Other | 34 | 23% |
| Unknown | 32 | 22% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 84 | 58% |
| Neuroscience | 10 | 7% |
| Engineering | 4 | 3% |
| Nursing and Health Professions | 3 | 2% |
| Psychology | 3 | 2% |
| Other | 8 | 5% |
| Unknown | 34 | 23% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 23 April 2017.
All research outputs
#17,193,840
of 25,257,066 outputs
Outputs from Intensive Care Medicine
#4,392
of 5,384 outputs
Outputs of similar age
#144,103
of 169,114 outputs
Outputs of similar age from Intensive Care Medicine
#17
of 21 outputs
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