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Lenell, S., Nyholm, L., Lewén, A. & Enblad, P. (2019). Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care. Acta Neurochirurgica, 161(6), 1243-1254
Åpne denne publikasjonen i ny fane eller vindu >>Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care
2019 (engelsk)Inngår i: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 161, nr 6, s. 1243-1254Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: The probability of favorable outcome after traumatic brain injury (TBI) decreases with age. Elderly,≥60 years, are an increasing part of our population. Recent studies have shown an increase of favorable outcome in elderly over time. However,the optimal patient selection and neurointensive care (NIC) treatments may differ in the elderly and the young. The aims of this study were to examine outcome in a larger group of elderly TBI patients receiving NIC and to identify demographic and treatmentrelated prognostic factors.

Methods: Patients with TBI≥60 years receiving NIC at our department between 2008 and 2014 were included. Demographics, co-morbidity, admission characteristics, and type of treatments were collected. Clinical outcome at around 6 months was assessed. Potential prognostic factors were included in univariate and multivariate regression analysis with favorable outcomeas dependent variable.

Results: Two hundred twenty patients with mean age 70 years (median 69; range 60–87) were studied. Overall, favorable outcome was 46% (Extended Glasgow Outcome Scale (GOSE) 5–8), unfavorable outcome 27% (GOSE 2–4), and mortality 27% (GOSE 1). Significant independent negative prognostic variables were high age (p< 0.05), multiple injuries (p<0.05),GCSM≤3 on admission (p< 0.05), and mechanical ventilation (p<0.001).

Conclusions: Overall, the elderly TBI patients> 60 years receiving modern NIC in this study had a fair chance of favorable outcome without large risks for severe deficits and vegetative state, also in patients over 75 years of age. High age, multiple injuries, GCS M≤3 on admission, and mechanical ventilation proved to be independent negative prognostic factors. The results underline that a selected group of elderly with TBI should have access to NIC

sted, utgiver, år, opplag, sider
SPRINGER WIEN, 2019
Emneord
Traumatic brain injury, Elderly, Outcome, Quality register, Neurointensive care, Prognostic factors
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-385969 (URN)10.1007/s00701-019-03893-6 (DOI)000468224800028 ()30980243 (PubMedID)
Tilgjengelig fra: 2019-06-18 Laget: 2019-06-18 Sist oppdatert: 2019-06-18bibliografisk kontrollert
Donald, R., Howells, T., Piper, I., Enblad, P., Nilsson, P., Chambers, I., . . . Stell, A. (2019). Forewarning of hypotensive events using a Bayesian artificial neural network in neurocritical care. Journal of clinical monitoring and computing, 33(1), 39-51
Åpne denne publikasjonen i ny fane eller vindu >>Forewarning of hypotensive events using a Bayesian artificial neural network in neurocritical care
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2019 (engelsk)Inngår i: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614, Vol. 33, nr 1, s. 39-51Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Traumatically brain injured (TBI) patients are at risk from secondary insults. Arterial hypotension, critically low blood pressure, is one of the most dangerous secondary insults and is related to poor outcome in patients. The overall aim of this study was to get proof of the concept that advanced statistical techniques (machine learning) are methods that are able to provide early warning of impending hypotensive events before they occur during neuro-critical care. A Bayesian artificial neural network (BANN) model predicting episodes of hypotension was developed using data from 104 patients selected from the BrainIT multi-center database. Arterial hypotension events were recorded and defined using the Edinburgh University Secondary Insult Grades (EUSIG) physiological adverse event scoring system. The BANN was trained on a random selection of 50% of the available patients (n = 52) and validated on the remaining cohort. A multi-center prospective pilot study (Phase 1, n = 30) was then conducted with the system running live in the clinical environment, followed by a second validation pilot study (Phase 2, n = 49). From these prospectively collected data, a final evaluation study was done on 69 of these patients with 10 patients excluded from the Phase 2 study because of insufficient or invalid data. Each data collection phase was a prospective non-interventional observational study conducted in a live clinical setting to test the data collection systems and the model performance. No prediction information was available to the clinical teams during a patient's stay in the ICU. The final cohort (n = 69), using a decision threshold of 0.4, and including false positive checks, gave a sensitivity of 39.3% (95% CI 32.9-46.1) and a specificity of 91.5% (95% CI 89.0-93.7). Using a decision threshold of 0.3, and false positive correction, gave a sensitivity of 46.6% (95% CI 40.1-53.2) and specificity of 85.6% (95% CI 82.3-88.8). With a decision threshold of 0.3, > 15min warning of patient instability can be achieved. We have shown, using advanced machine learning techniques running in a live neuro-critical care environment, that it would be possible to give neurointensive teams early warning of potential hypotensive events before they emerge, allowing closer monitoring and earlier clinical assessment in an attempt to prevent the onset of hypotension. The multi-centre clinical infrastructure developed to support the clinical studies provides a solid base for further collaborative research on data quality, false positive correction and the display of early warning data in a clinical setting.

Emneord
Traumatic brain injury, Neuro-intensive care, Bayesian prediction, Clinical study results
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-374422 (URN)10.1007/s10877-018-0139-y (DOI)000454820400007 ()29799079 (PubMedID)
Forskningsfinansiär
EU, Horizon 2020, IST-2007-217049
Tilgjengelig fra: 2019-01-29 Laget: 2019-01-29 Sist oppdatert: 2019-01-29bibliografisk kontrollert
Vlachogiannis, P., Hillered, L., Khalil, F., Enblad, P. & Ronne-Engström, E. (2019). Interleukin-6 Levels in Cerebrospinal Fluid and Plasma in Patients with Severe Spontaneous Subarachnoid Hemorrhage. World Neurosurgery, 122, E612-E618
Åpne denne publikasjonen i ny fane eller vindu >>Interleukin-6 Levels in Cerebrospinal Fluid and Plasma in Patients with Severe Spontaneous Subarachnoid Hemorrhage
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2019 (engelsk)Inngår i: World Neurosurgery, ISSN 1878-8750, E-ISSN 1878-8769, Vol. 122, s. E612-E618Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Inflammatory processes play a key role in the pathophysiology of subarachnoid hemorrhage (SAH). This study evaluated whether different temporal patterns of intrathecal and systemic inflammation could be identified in the acute phase after SAH. The intensity of the inflammation was also assessed in clinical subgroups. METHODS: Cerebrospinal fluid (CSF) and blood samples were collected at days 1, 4, and 10 after ictus in 44 patients with severe SAH. Interleukin-6 (IL-6) was analyzed by a routine monoclonal antibody-based method. Median IL-6 values for each day were calculated. Day 4 IL-6 values were compared in dichotomized groups (age, sex, World Federation of Neurosurgical Societies [WFNS] grade, Fisher scale grade, outcome, vasospasm, central nervous system infection and systemic infections). RESULTS: CSF IL-6 levels were significantly elevated from day 1 to days 4 and 10, whereas plasma IL-6 showed a different trend at lower levels. Median CSF IL-6 concentrations for days 1, 4, and 10 were 876.5, 3361, and 1567 ng/L, whereas plasma was 26, 27.5, and 15.9 ng/L, respectively. No significant differences in CSF concentrations were observed between the subgroups, with the most prominent one being in day 4 IL-6 in the WFNS subgroups (grades 1-3 vs. 4-5, 1158.5 vs. 5538 ng/L; P = 0.056). Patients with systemic infection had significantly higher plasma IL-6 concentrations than patients without infection (31 vs. 16.05 ng/L, respectively; P = 0.028). CONCLUSIONS: Distinctly different inflammatory patterns could be seen intrathecally compared with the systemic circulation. In plasma, a significant difference in the intensity of the inflammation was seen in cases with systemic infection. No other subgroup showed statistically significant differences.

sted, utgiver, år, opplag, sider
ELSEVIER SCIENCE INC, 2019
Emneord
Inflammatory response, Interleukin-6, Neuroinflammation, SAH, Subarachnoid hemorrhage
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-377213 (URN)10.1016/j.wneu.2018.10.113 (DOI)000457328100075 ()
Tilgjengelig fra: 2019-02-25 Laget: 2019-02-25 Sist oppdatert: 2019-02-25bibliografisk kontrollert
Abu Hamdeh, S., Marklund, N., Lewén, A., Howells, T., Raininko, R., Wikström, J. & Enblad, P. (2019). Intracranial pressure elevations in diffuse axonal injury: association with nonhemorrhagic MR lesions in central mesencephalic structures. Journal of Neurosurgery, 131(2), 604-611
Åpne denne publikasjonen i ny fane eller vindu >>Intracranial pressure elevations in diffuse axonal injury: association with nonhemorrhagic MR lesions in central mesencephalic structures
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2019 (engelsk)Inngår i: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 131, nr 2, s. 604-611Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: Increased intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI) with diffuse axonal injury (DAI) is not well defined. This study investigated the occurrence of increased ICP and whether clinical factors and lesion localization on MRI were associated with increased ICP in patients with DAI.

Methods: Fifty-two patients with severe TBI (median age 24 years, range 9–61 years), who had undergone ICP monitoring and had DAI on MRI, as determined using T2*-weighted gradient echo, susceptibility-weighted imaging, and diffusion-weighted imaging (DWI) sequences, were enrolled. The proportion of good monitoring time (GMT) with ICP > 20 mm Hg during the first 120 hours postinjury was calculated and associations with clinical and MRI-related factors were evaluated using linear regression.

Results: All patients had episodes of ICP > 20 mm Hg. The mean proportion of GMT with ICP > 20 mm Hg was 5%, and 27% of the patients (14/52) spent more than 5% of GMT with ICP > 20 mm Hg. The Glasgow Coma Scale motor score at admission (p = 0.04) and lesions on DWI sequences in the substantia nigra and mesencephalic tegmentum (SN-T, p = 0.001) were associated with the proportion of GMT with ICP > 20 mm Hg. In multivariable linear regression, lesions on DWI sequences in SN-T (8% of GMT with ICP > 20 mm Hg, 95% CI 3%–13%, p = 0.004) and young age (−0.2% of GMT with ICP > 20 mm Hg, 95% CI −0.07% to −0.3%, p = 0.002) were associated with increased ICP.

Conclusions: Increased ICP occurs in approximately one-third of patients with severe TBI who have DAI. Age and lesions on DWI sequences in the central mesencephalon (i.e., SN-T) are associated with elevated ICP. These findings suggest that MR lesion localization may aid prediction of increased ICP in patients with DAI.

Abbreviations: ADC = apparent diffusion coefficient; CPP = cerebral perfusion pressure; DAI = diffuse axonal injury; DWI = diffusion-weighted imaging; EVD = external ventricular drain; GCS = Glasgow Coma Scale; GMT = good monitoring time; GOSE = Glasgow Outcome Scale–Extended; ICC = intraclass correlation coefficient; ICP = intracranial pressure; MAP = mean arterial blood pressure; NICU = neurointensive care unit; SN-T = substantia nigra and mesencephalic tegmentum; SWI = susceptibility-weighted imaging; TBI = traumatic brain injury; T2*GRE = T2*-weighted gradient echo.

Emneord
diffuse axonal injury, MRI, elevated ICP, intracranial pressure, TBI, traumatic brain injury, diffusion-weighted imaging, trauma
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-362207 (URN)10.3171/2018.4.JNS18185 (DOI)000478642100036 ()30215559 (PubMedID)
Merknad

Correction in: JOURNAL OF NEUROSURGERY, Volume: 131, Issue: 2, Pages: 637-638, DOI: 10.3171/2018.10.JNS18185a

Tilgjengelig fra: 2018-10-02 Laget: 2018-10-02 Sist oppdatert: 2019-10-18bibliografisk kontrollert
Dyhrfort, P., Shen, Q., Clausen, F., Eriksson, M., Enblad, P., Kamali-Moghaddam, M., . . . Hillered, L. (2019). Monitoring of Protein Biomarkers of Inflammation in Human Traumatic Brain Injury Using Microdialysis and Proximity Extension Assay Technology in Neurointensive Care. Journal of Neurotrauma, 36(20), 2872-2885
Åpne denne publikasjonen i ny fane eller vindu >>Monitoring of Protein Biomarkers of Inflammation in Human Traumatic Brain Injury Using Microdialysis and Proximity Extension Assay Technology in Neurointensive Care
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2019 (engelsk)Inngår i: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 36, nr 20, s. 2872-2885Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Traumatic brain injury (TBI) is followed by secondary injury mechanisms strongly involving neuroinflammation. To monitor the complex inflammatory cascade in human TBI, we used cerebral microdialysis (MD) and multiplex proximity extension assay (PEA) technology and simultaneously measured levels of 92 protein biomarkers of inflammation in MD samples every three hours for five days in 10 patients with severe TBI under neurointensive care. One mu L MD samples were incubated with paired oligonucleotide-conjugated antibodies binding to each protein, allowing quantification by real-time quantitative polymerase chain reaction. Sixty-nine proteins were suitable for statistical analysis. We found five different patterns with either early (<48 h; e.g., CCL20, IL6, LIF, CCL3), mid (48-96 h; e.g., CCL19, CXCL5, CXCL10, MMP1), late (>96 h; e.g., CD40, MCP2, MCP3), biphasic peaks (e.g., CXCL1, CXCL5, IL8) or stable (e.g., CCL4, DNER, VEGFA)/low trends. High protein levels were observed for e.g., CXCL1, CXCL10, MCP1, MCP2, IL8, while e.g., CCL28 and MCP4 were detected at low levels. Several proteins (CCL8, -19, -20, -23, CXCL1, -5, -6, -9, -11, CST5, DNER, Flt3L, and SIRT2) have not been studied previously in human TBI. Cross-correlation analysis revealed that LIF and CXCL5 may play a central role in the inflammatory cascade. This study provides a unique data set with individual temporal trends for potential inflammatory biomarkers in patients with TBI. We conclude that the combination of MD and PEA is a powerful tool to map the complex inflammatory cascade in the injured human brain. The technique offers new possibilities of protein profiling of complex secondary injury pathways.

sted, utgiver, år, opplag, sider
MARY ANN LIEBERT, INC, 2019
Emneord
biomarkers, inflammation, microdialysis, molecular tools, neurointensive care, proteomics, traumatic brain injury
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-396069 (URN)10.1089/neu.2018.6320 (DOI)000472621900001 ()31017044 (PubMedID)
Forskningsfinansiär
Swedish Research CouncilVinnova
Tilgjengelig fra: 2019-10-30 Laget: 2019-10-30 Sist oppdatert: 2019-10-30bibliografisk kontrollert
Engquist, H., Rostami, E. & Enblad, P. (2019). Temporal Dynamics of Cerebral Blood Flow During the Acute Course of Severe Subarachnoid Hemorrhage Studied by Bedside Xenon-Enhanced CT. Neurocritical Care, 30(2), 280-290
Åpne denne publikasjonen i ny fane eller vindu >>Temporal Dynamics of Cerebral Blood Flow During the Acute Course of Severe Subarachnoid Hemorrhage Studied by Bedside Xenon-Enhanced CT
2019 (engelsk)Inngår i: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 30, nr 2, s. 280-290Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Compromised cerebral blood flow (CBF) is a crucial factor in delayed cerebral ischemia after subarachnoid hemorrhage (SAH). Repeated measurement of CBF may improve our understanding of the temporal dynamics following SAH. The aim of this study was to assess CBF at different phases of the acute course in poor-grade SAH patients, hypothesizing more pronounced disturbances at day 4-7, and that the initial level of CBF determines the following course of CBF.

Methods: Mechanically ventilated SAH patients were scheduled for bedside measurement of regional and global cortical CBF at day 0-3, 4-7, and 8-12, using xenon-enhanced computed tomography in a mobile setup. Patients were dichotomized depending on high or low initial global cortical CBF and cutoff level 30ml/100g/min.

Results: Eighty-one patients were included, and 51 had measurements at day 0-3 and 4-7. In patients with high initial CBF, the level was unchanged at day 4-7; 37.7 (IQR 32.6-46.7) ml/100g/min versus 36.8 (IQR 29.5-44.8). The low-CBF group showed a slight increase from 23.6 (IQR 21.0-28.1) ml/100g/min to 28.4 (IQR 22.7-38.3) (P=0.025), still markedly lower than the high-CBF group (P=0.016). In the low-CBF group, CBF increased in patients who received hypertension, hypervolemia, and hemodilution (HHH therapy) but remained low in standard treated patients. For the subset of 27 patients examined also at day 8-12, the differences depending on initial CBF level were no longer statistically significant. Among patients with still low CBF at day 4-7, the proportion who had poor short-term outcome was 55% compared to 35% (n.s.) for patients with high CBF.

Conclusions: CBF studied in poor-grade SAH patients at large did not show any statistically significant changes over time. Stratifying patients by high or low initial CBF and whether HHH therapy was given revealed an association between low initial CBF and persistent low CBF at day 4-7. These findings may be of clinical relevance in managing SAH patients with low early CBF.

sted, utgiver, år, opplag, sider
HUMANA PRESS INC, 2019
Emneord
Subarachnoid hemorrhage, Delayed cerebral ischemia, Cerebral blood flow, Xenon-CT, XeCT, Temporal, Sequential
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-380427 (URN)10.1007/s12028-019-00675-x (DOI)000461380900008 ()30790226 (PubMedID)
Tilgjengelig fra: 2019-04-01 Laget: 2019-04-01 Sist oppdatert: 2019-04-01bibliografisk kontrollert
Svedung-Wettervik, T., Howells, T., Enblad, P. & Lewén, A. (2019). Temporal Neurophysiological Dynamics in Traumatic Brain Injury: Role of Pressure Reactivity and Optimal Cerebral Perfusion Pressure for Predicting Outcome. Journal of Neurotrauma, 36(11), 1818-1827
Åpne denne publikasjonen i ny fane eller vindu >>Temporal Neurophysiological Dynamics in Traumatic Brain Injury: Role of Pressure Reactivity and Optimal Cerebral Perfusion Pressure for Predicting Outcome
2019 (engelsk)Inngår i: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 36, nr 11, s. 1818-1827Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Intracranial pressure (ICP), cerebral perfusion pressure (CPP), and the pressure reactivity index (PRx) have been shown to correlate with outcome after traumatic brain injury (TBI), but their temporal evolution is less studied. Optimal CPP (CPPopt; i.e., the CPP with the lowest [optimal] PRx value) has been proposed as a dynamic, individualized CPP target. Our aim was to map the temporal course of these parameters and their relation to outcome, in particular the extent and impact of CPP insults based both on fixed CPP thresholds and on divergence from CPPopt. Data from 362 TBI patients with ICP-monitoring treated at the neurointensive care unit of Uppsala University Hospital, Uppsala, Sweden, between 2008-2016 were retrospectively analyzed for the temporal course of ICP, mean arterial blood pressure, CPP, PRx, PRx55-15 (a variant of PRx), and CPPopt the first 10 days post-injury. PRx and PRx55-15 showed significantly lower/better values for those with favorable outcome, most pronounced on Days 2 to 5. PRx55-15 gave better separation between the two groups. In the univariate analysis, CPP insults (both fixed and CPPopt-thresholds) were significantly correlated with outcome on these days. Multi-variate logistic regression showed that age, Glasgow Coma Score Motor, pupillary abnormality at admission, CPP > CPPopt, and PRx55-15 were significant independent outcome predictors. PRx was significant when PRx55-15 was excluded. High PRx55-15 and high grade of monitoring time with CPP > CPPopt, but not the traditional fixed CPP thresholds, were strong predictors for worse clinical outcome. The study supports the concept that CPPopt is an important parameter in TBI management.

sted, utgiver, år, opplag, sider
MARY ANN LIEBERT, INC, 2019
Emneord
cerebral autoregulation, CPPopt, neurointensive care, traumatic brain injury
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-387934 (URN)10.1089/neu.2018.6157 (DOI)000470007600012 ()30595128 (PubMedID)
Tilgjengelig fra: 2019-06-27 Laget: 2019-06-27 Sist oppdatert: 2019-06-27bibliografisk kontrollert
Lewén, A., Dyhrfort, P., Clausen, F., Enblad, P. & Hillered, L. (2018). A Dedicated 21-Plex Pea Panel For High-Sensitive Protein Biomarker Detection Using Micro-Dialysis In Traumatic Brain Injury. Paper presented at 3rd Joint Symposium of the International-and-National-Neurotrauma-Societies-and-AANS/CNS-Section on Neurotrauma and Critical Care, AUG 11-16, 2018, Toronto, CANADA. Journal of Neurotrauma, 35(16), A130-A130
Åpne denne publikasjonen i ny fane eller vindu >>A Dedicated 21-Plex Pea Panel For High-Sensitive Protein Biomarker Detection Using Micro-Dialysis In Traumatic Brain Injury
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2018 (engelsk)Inngår i: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 35, nr 16, s. A130-A130Artikkel i tidsskrift, Meeting abstract (Annet vitenskapelig) Published
sted, utgiver, år, opplag, sider
MARY ANN LIEBERT, INC, 2018
Emneord
Biomarker, Inflammation / Immune Function, Monitoring, Neurocritical Care
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-363876 (URN)000441527400353 ()
Konferanse
3rd Joint Symposium of the International-and-National-Neurotrauma-Societies-and-AANS/CNS-Section on Neurotrauma and Critical Care, AUG 11-16, 2018, Toronto, CANADA
Tilgjengelig fra: 2018-11-12 Laget: 2018-11-12 Sist oppdatert: 2018-11-12bibliografisk kontrollert
Enblad, P. (2018). Continuous monitoring of intracranial compliance in neurointensive care (Editorial by invitation). Acta Neurochirurgica, 160(12), 2289-2290
Åpne denne publikasjonen i ny fane eller vindu >>Continuous monitoring of intracranial compliance in neurointensive care (Editorial by invitation)
2018 (engelsk)Inngår i: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 160, nr 12, s. 2289-2290Artikkel i tidsskrift, Editorial material (Annet vitenskapelig) Published
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-373526 (URN)10.1007/s00701-018-3682-x (DOI)000450984500002 ()30334098 (PubMedID)
Tilgjengelig fra: 2019-01-15 Laget: 2019-01-15 Sist oppdatert: 2019-01-15bibliografisk kontrollert
Svedung Wettervik, T., Lenell, S., Nyholm, L., Howells, T., Lewén, A. & Enblad, P. (2018). Decompressive craniectomy in traumatic brain injury: usage and clinical outcome in a single centre. Acta Neurochirurgica, 160(2), 229-237
Åpne denne publikasjonen i ny fane eller vindu >>Decompressive craniectomy in traumatic brain injury: usage and clinical outcome in a single centre
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2018 (engelsk)Inngår i: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 160, nr 2, s. 229-237Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Two randomised controlled trials (RCTs) of decompressive craniectomy (DC) in traumatic brain injury (TBI) have shown poor outcome, but there are considerations of how these protocols relate to real practice. The aims of this study were to evaluate usage and outcome of DC and thiopental in a single centre.

Method: The study included all TBI patients treated at the neurointensive care unit, Akademiska sjukhuset, Uppsala, Sweden, between 2008 and 2014. Of 609 patients aged 16 years or older, 35 treated with DC and 23 treated with thiopental only were studied in particular. Background variables, intracranial pressure (ICP) measures and global outcome were analysed.

Results: Of 35 DC patients, 9 were treated stepwise with thiopental before DC, 9 were treated stepwise with no thiopental before DC and 17 were treated primarily with DC. Six patients received thiopental after DC. For 23 patients, no DC was needed after thiopental. Eighty-eight percent of our DC patients would have qualified for the DECRA study and 38% for the Rescue-ICP trial. Favourable outcome was 44% in patients treated with thiopental before DC, 56% in patients treated with DC without prior thiopental, 29% in patients treated primarily with DC and 52% in patients treated with thiopental with no DC.

Conclusions: The place for DC in TBI management must be evaluated better, and we believe it is important that future RCTs should have clearer and less permissive ICP criteria regarding when thiopental should be followed by DC and DC followed by thiopental.

sted, utgiver, år, opplag, sider
SPRINGER WIEN, 2018
Emneord
Traumatic brain injury, Neurointensive care, Standardised treatment protocol, Decompressive craniectomy, Thiopental
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-341558 (URN)10.1007/s00701-017-3418-3 (DOI)000419961200003 ()29234973 (PubMedID)
Tilgjengelig fra: 2018-02-13 Laget: 2018-02-13 Sist oppdatert: 2018-08-24bibliografisk kontrollert
Organisasjoner
Identifikatorer
ORCID-id: ORCID iD iconorcid.org/0000-0003-4364-1919