Thomas Lescot1, Lamine Abdennour, Anne-Laure Boch, Louis Puybasset. 1. Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie-Paris 6, Paris, France.
Abstract
PURPOSE OF REVIEW: The review provides key points and recent advances regarding the treatments of intracranial hypertension as a consequence of traumatic brain injury. The review is based on the pathophysiology of brain edema and draws on the current literature as well as clinical bedside experience. RECENT FINDINGS: The review will cite baseline literature and discuss emerging data on cerebral perfusion pressure, sedation, hypothermia, osmotherapy and albumin as treatments of intracranial hypertension in traumatic brain-injured patients. SUMMARY: One of the key issues is to consider that traumatic brain injury is more likely a syndrome than a disease. In particular, the presence or absence of a high contusional volume could influence the treatments to be implemented. The use of osmotherapy and/or high cerebral perfusion pressure should be restricted to patients without major contusions. Some physiopathological, experimental and clinical data, however, show that corticosteroids and albumin--therapies that have been proven deleterious if administered systematically--are worth reconsidering for this subgroup of patients. The current Pitié-Salpêtrière algorithm, where treatments are stratified according to their potential side effects, will be added at the end of the review as an example of an integrated strategy.
PURPOSE OF REVIEW: The review provides key points and recent advances regarding the treatments of intracranial hypertension as a consequence of traumatic brain injury. The review is based on the pathophysiology of brain edema and draws on the current literature as well as clinical bedside experience. RECENT FINDINGS: The review will cite baseline literature and discuss emerging data on cerebral perfusion pressure, sedation, hypothermia, osmotherapy and albumin as treatments of intracranial hypertension in traumatic brain-injuredpatients. SUMMARY: One of the key issues is to consider that traumatic brain injury is more likely a syndrome than a disease. In particular, the presence or absence of a high contusional volume could influence the treatments to be implemented. The use of osmotherapy and/or high cerebral perfusion pressure should be restricted to patients without major contusions. Some physiopathological, experimental and clinical data, however, show that corticosteroids and albumin--therapies that have been proven deleterious if administered systematically--are worth reconsidering for this subgroup of patients. The current Pitié-Salpêtrière algorithm, where treatments are stratified according to their potential side effects, will be added at the end of the review as an example of an integrated strategy.
Authors: Thomas Lescot; Vincent Reina; Yannick Le Manach; Filippo Boroli; Dorian Chauvet; Anne-Laure Boch; Louis Puybasset Journal: Intensive Care Med Date: 2011-02-26 Impact factor: 17.440