Traumatic Craniocerebral Injury Research Articles

Effects of positive end-expiratory pressure setting of mechanical ventilation guided by esophageal pressure in the treatment of patients with traumatic craniocerebral injury combined with acute respiratory distress syndrome

Objective: To investigate the effects of positive end-expiratory pressure (PEEP) setting of mechanical ventilation guided by esophageal pressure in the treatment of patients with traumatic craniocerebral injury combined with acute respiratory distress syndrome (ARDS). Methods: The retrospective cohort study was conducted. From June 2016 to June 2018, 55 patients with traumatic craniocerebral injury combined with ARDS who met the inclusion criteria were admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University. According to PEEP setting method, 28 patients were allocated to esophageal pressure group (17 males and 11 females, aged (40±13) years) and 27 patients were allocated to PEEP-fractional concentration of inspired oxygen (FiO2) table group (18 males and 9 females, aged (38±10) years). Patients in the 2 groups were treated with mechanical ventilation guided by lung protective ventilation strategy, and the optimal PEEP at 0 (immediately), 24, 48, and 72 h after treatment was determined according to esophageal pressure and PEEP-FiO2 table, respectively. The mechanical ventilation parameters in the 2 groups were adjusted according to the optimal PEEP. The transpulmonary end-expiratory pressure, pulmonary compliance, oxygen index, central venous pressure, mean arterial pressure, and intracranial pressure at 24, 48, and 72 h after treatment were recorded. Data were statistically analyzed with analysis of variance for repeated measurement, chi-square test, independent sample t test, and Bonferroni correction. Results: The optimal PEEP of patients in esophageal pressure group at 0, 24, 48, and 72 h after treatment was (12.4±3.9), (11.2±3.5), (13.4±2.6), and (13.2±3.6) cmH2O (1 cmH2O=0.098 kPa), respectively, which was significantly higher than (8.2±2.5), (7.4±2.2), (8.3±2.3), and (8.5±2.5) cmH2O in PEEP-FiO2 table group, respectively (t=4.702, 4.743, 7.849, 5.623, P<0.01). The transpulmonary end-expiratory pressure and pulmonary compliance at 24, 48, and 72 h after treatment and oxygen index at 48 and 72 h after treatment of patients in esophageal pressure group were significantly higher than those in PEEP-FiO2 table group (t=17.852, 20.586, 19.532, 4.752, 5.256, 7.446, 2.342, 4.178, P<0.05 or P<0.01). The central venous pressure of patients in esophageal pressure group at 24, 48, and 72 h after treatment was significantly higher than that in PEEP-FiO2 table group (t=12.632, 5.247, 8.994, P<0.01), and there was no statistically significant difference in mean arterial pressure of patients between the 2 groups at 24, 48, and 72 h after treatment (P>0.05). The intracranial pressure of patients in esophageal pressure group was higher than that in PEEP-FiO2 table group at 24, 48, and 72 h after treatment, but there was no statistically significant difference between the 2 groups (P>0.05). Conclusions: For patients with traumatic craniocerebral injury combined with ARDS, the optimal PEEP can be set under the guidance of esophageal pressure method, and the mechanical ventilation parameters adjusted according to the optimal PEEP can improve lung compliance and accelerate recovery of lung function more effectively, with no adverse effect in mean arterial pressure and intracranial pressure.

Application of standard decompressive craniectomy in the treatment of traumatic brain injury

Traumatic craniocerebral injury has been paid close attention by neurosurgeons at home and abroad due to its high morbidity and mortality. Cerebral contusion and intracranial hematoma caused by various injury mechanisms are the main causes of increased intracranial pressure in the acute stage of traumatic brain injury. As a classic surgical method, standard decompressive craniotomy, often together with intracranial hematoma evacuation, brain debridement and internal decompression, has become the main surgical treatment in the acute stage of traumatic brain injury, saving the lives of many patients with severe cerebral injury, the importance of this procedure is irreplaceable. In long-term clinical practice, through the unremitting efforts of first-line neurosurgeons and neuroscientists, a large number of studies have been conducted on the relationship between the details, norms and prognosis of craniotomy, so as to better regulate the treatment of traumatic brain injury and reduce the death and disability rate of patients with severe brain injury. This article systematically reviews and analyzes the pathophysiological mechanism of intracranial hypertension and the mechanism, development history, surgical methods, indications and contraindications, prognosis and prospects of the intracranial hypertension. Through this article, the author hope to have some guidance and suggestions for future clinical work. Key words: Craniocerebral trauma; Intracranial pressure; Decompressive craniectomy

Late-onset Development of Tachylalia Following a Closed Traumatic Craniocerebral Injury Associated with Bitemporal Gliosis

Tachylalia is defined as extremely rapid output of speech. A case of delayed development of tachylalia 4 years following sustaining a closed craniocerebral injury is reported. We suggest that the management of communication disorders should always be considered as a part of treatment and rehabilitation of traumatic head injury. In a detailed PubMed and Medline search for late-onset tachylalia, development following traumatic craniocerebral injury did not yield even a single report in the literature. The multidisciplinary approach in management of such rare event is highly crucial.

Effective treatment via early cranioplasty for intractable contralateral subdural effusion after standard decompressive craniectomy in patients with severe traumatic brain injury

ObjectiveThis study aimed to introduce an effective treatment for intractable contralateral subdural effusion after standard decompressive craniectomy in patients with severe traumatic brain injury (TBI) and to analyze the underlying mechanism. MethodsA retrospective analysis was performed in 13 patients with severe traumatic craniocerebral injury showing complicated intractable contralateral subdural effusion after standard decompressive craniectomy, in whom satisfactory results were not obtained from treatments, including compression bandaging, head-down bed rest (HDBR), continuing lumbar drainage, and Ommaya catheter drainage. Among these patients, 6 underwent temporal muscle sticking, while 7 underwent early cranioplasty. The postoperative changes in the subdural effusion were observed. ResultsIn the 6 patients who underwent temporal muscle sticking and the 7 who underwent early cranioplasty, the subdural effusion completely resolved or was significantly reduced within one month, and no recurrence was observed in the 6-month follow-up period. However, secondary bilateral cranioplasty was still necessary in the postoperative 3–6 months for the patients who underwent temporal muscle sticking. In the early cranioplasty group, there were three total operations, and the average length of stay (ALOS) was 76days. In the temporal muscle sticking group, there were four total operations, and the ALOS was 56.1days. A retrospective analysis of surgical pain showed that 100% of the patients in the first group experienced unacceptable suffering, while 14.3% of the patients in the second group experienced pain. ConclusionEarly cranioplasty is an effective, economical, and less painful treatment for intractable contralateral subdural effusion after standard decompressive craniectomy.

Patterns of Cranio-cerebral Injuries in Fatal Head Trauma

The objective of this study was to find out pattern of cranio-cerebral injuries in medico-legal cases of fatal head trauma with regards to age, sex, survival period, causes and complications leading to death of the victim. Materials were collected from 48 medico-legal cases of fatal head injury which were brought for autopsy at the mortuary of PCMS & RC, Bhopal from 01 Jan 2011 to 31Dec 2011. It was found that most commonly involved age group was 21–40 with male outnumbering the female in a ratio of 4.9 to 1. Vehicular accident was the leading cause for fatalities in 91.66% cases. 18.75% died on the spot while 45.83% of the remaining survived for 0–12 hrs. Fractures of the skull had occurred in around 81.25% of the cases. Among whole of skull cap temporal bone was most prone to fracture (22.91%) while linear/fissured fracture was the commonest type (35.41%). SDH was noted in 31.25% of cases. 18.75% deaths had occurred on the spot while 45.83% of the remaining had survived for 0–12 hrs. Traumatic cranio-cerebral injury was the primary cause of death in slightly more than the half of the victims (52.08%) indicating that timely intervention could have saved the lives of unfortunate hapless victims.

Relationship between changes of serum sex hormones and prognosis in patients with acute craniocerebral injury

Objective To evaluate the effects of the dynamic changes of serum sex hormones on the injury severity and prognosis of acute craniocerebral injury.Methods The injury severity (light,medium,and heavy) was evaluated through GCS score and the prognosis was evaluated with GOS.Intravenous blood was collected respectively from 153 patients with light,medium,and heavy injury at the first day and the 7th day after acute head injury.The quantitative method was used dynamically to determine the sexual hormone contents (serum E2,P,and T) in the serum.The relationships among the dynamic changes of serum sex hormones,the severity of injury and the prognosis after acute craniocerebral injury were analyzed.Results The contents of the serum E2,P,and T at the first day after injury were increased significantly than those at the seventh day in the patients with all types of acute head injury.Meanwhile,the changes showed that the contents of the serum E2,P,and T were increased with the decrease of GCS score at both time points.There was a negative correlation between the contents of serum E2,P,and T and the GCS score and GOS score (P ＜ 0.05).Conclusions Early dynamically monitoring the changes of sexal hormone contents in serum of patients with acute traumatic craniocerebral injury could be used as the early indicators of rapid judgment of injury severity and prognosis.It could provide the basis for intervene therapy (proper application of sex hormones) in patients with acute craniocerebral injury. Key words: Acute craniocerebral injury; Sex hormones; Injury severity; Prognosis

Applicational research progress of Glasgow Coma Scale, Children Coma Scale and Trauma Infant Neurologic Score in children with traumatic craniocerebral injury

Traumatic craniocerebral injury is one of serious injury which can cause great damage to human life and health even lead to disability or death.Making an objective and accurate judgement of severity and prognosis for traumatic craniocerebral injury in children, which might play an important role in the clinical treatment and prognosis.As a physical scoring indicator system of traumatic craniocerebral injury, the earliest and most widely used one is Glasgow Coma Scale.The Children Coma Scale is particularly used for children under 4 years old and the Trauma Infant Neurologic Score for infants with traumatic craniocerebral injury.Thus, these 3 scoring systems present advantage and representative in clinical application.Here we make a brief review on these 3 scoring systems based on the current studies and applications. Key words: Traumatic craniocerebral injury; Glasgow Coma Scale; Children Coma Scale; Trauma Infant Neurologic Score; Child

Analysis on association of plasma Clara cell protein concentration with acute lung injury secondary to severe traumatic injury

Objective To determine the plasma Clara cell protein concentration in patients with severe traumatic craniocerebral injury and to evaluate its prognostic value for acute lung injury and acute respiratory distress syndrome (ARDS).Methods 112 patients with severe traumatic craniocerebral injury were recruited.The concentration of plasma Clara cell protein was measured with ELISA.Its correlation with acute lung injury and ARDS was analyzed statistically.Results 36 patients (32.1％) suffered from acute lung injury and 14 patients (12.5％) had ARDS.A multivariate logistic regression showed that the plasma Clara cell protein concentration was an independent predictor for acute lung injury (Or =1.352,95％ CI =1.121 ～3.457,P ＜0.01) and ARDS (Or =1.442,95％ CI =1.139 ～3.782,P ＜0.01).A receiver operating characteristic curve showed that the plasma Clara cell protein level ＞ 26.6 ng/ml predicted acute lung injury with 83.3％ sensitivity and 76.3％ specificity (area under curve =0.847,95％ CI =0.782 ～ 0.909,P ＜ 0.01) and that plasma Clara cell protein level ＞ 27.4 ng/ml predicted ARDS with 78.6％ sensitivity and 83.7％ specificity (area under curve =0.856,95％ CI =0.791 ～ 0.917,P ＜ 0.01).Conclusions The plasma Clara cell protein concentration could predict acute lung injury and ARDS secondary to severe traumatic craniocerebral injury. Key words: Clara cell protein; Severe traumatic injury; Acute lung injury; Acute respiratory distress syndrome

Social support status of first degree relatives of traumatic craniocerebral injury patienets

Objective To learn social support status of first degree relatives of traumatic craniocerebral injury patients, and to provide reference for effective social recourse. Methods Social support status of first degree relatives of 300 traumatic craniocerebral injury patienets were investigated with Social Support Scale. Results The total score of social support of first degree relatives in this study was higher than the norm (P<0. 01). The factors influcing their social support includs acquiring information, dwelling place, psychosis factors, medical cost, occupation, hospital days of patients, self-comfort demand, support demand and the age of first degree relatives. Conclusions The total level of social support of first degree relatives of traumatic craniocerebral injury patienets is high, medical staff should guide them to make the best use of social resource to improve coping capacity of traumatic events. Key words: Craniocerebral injury; Relatives; Social support

Spezielle pädiatrische Neuroanästhesie und Neurochirurgie

Paediatric neurosurgical procedures request special considerations for the anaesthetic management. Due to patients age and diagnostic findings certain therapeutic procedures are performed under anaesthetic care. Main reasons for craniotomy are hydrocephalus, intracranial tumors and craniofacial synostosis. Neurosurgical therapy of newborn children is related mostly to hereditary spinal dysraphism. In spinal surgery and specific intracranial procedures for monitoring reasons sensory and/or motor evoked potentials (SEP, MEP) are used to improve surgical outcome. Due to sensibility for anaesthetic drugs these techniques request sound knowledge of physiologic and pharmacologic interaction. Cerebrovascular malformations are today usually treated using radiologic interventional procedures. Operative access will be performed for selected cases additionally to embolization, but is associated with risk of massive bleeding. Severe traumatic craniocerebral injury leads to compromised cerebral blood flow and hypoxic ischemia. The article imparts funded knowledge of surgical as well as anaesthetic rationale and techniques in neuropaediatric therapies.

Hospital Lethality in Concomitant Injury and Possi­bility of Its Reduction

Hospital lethality in victims with polytrauma who had been treated at specialized Polytrauma Center (Barnaul City Hospital # 1) during 1997-2002 was analyzed. Total number of patients made up 3878 including 617 (15,9%) lethal cases. It was shown that the level of hospital lethality was dependent upon such factors as age, inner organs and cranio-cerebral injuries, severity of both traumatic shock and cranio-cerebral injury. Authors believe that after emergency specialized care all patients with concomitant injury independently of a dominant injury should be hospitalized to special department of multiple and concomitant injury. In 2000 such de­partment was organized within the structure of Center and that enabled to reduce hospital lethality from 18,2% to 13,4%.

Pathology of experimental traumatic craniocerebral missile injury

The neuropathological alterations in sheep associated with head wounds inflicted by a .22 calibre rifle are reported. Brain damage was manifest as a permanent haemorrhagic wound cavity produced by crushing and laceration of tissue during missile penetration, secondary tracks due to bone and bullet fragments, widely distributed stretch injuries to blood vessels, nerve fibres and neurons as a consequence of the radial forces of the temporary cavity which develops as a bullet penetrates tissue, marked subarachnoid and intraventricular haemorrhage, and distortion and displacement of the brain.