Neurological research
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Neurological research · Mar 2001
ReviewUse of sedative and analgesic agents in neurotrauma patients: effects on cerebral physiology.
Sedation and analgesia is used primarily in the intensive care unit (ICU) to limit the stress response to critical illness, provide anxiolysis, improve ventilatory support, and facilitate adequate ICU care. However, in the neurotrauma ICU there are many other reasons for the use of these agents. The primary aim is to prevent secondary cerebral damage by maintaining adequate cerebral perfusion pressures. ⋯ Concerns surrounding the use of these agents include time to awakening after discontinuation, effect on the cerebrovasculature, and the effect on patient outcome. There are many different pharmacological agents available, each with their distinct advantages and disadvantages. The purpose of this review is to evaluate the pharmacokinetic and pharmacological effects of each of these agents when used in neurotrauma patients.
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Neurological research · Mar 2001
ReviewBedside invasive monitoring techniques in severe brain-injured patients.
In patients with severe brain injury, brain edema, elevated intracranial pressure, and cerebral ischemia are accountable for a significant morbidity and mortality. New invasive methods of monitoring attempt to foresee the physiopathological mechanisms responsible for the production of secondary brain injuries. The available methods for monitoring severely brain-injured patients, their potential usefulness, advantages, and disadvantages are reviewed.
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The purpose of our study was to describe the outcomes of persons with penetrating brain injury resulting from a gunshot wound to the head. It is a prospective study of 442 patients admitted with gunshot wounds to the head over a 7 year period to our University Trauma Center Emergency Department, an urban trauma center and an inpatient rehabilitation hospital with a specialized brain injury unit. Measures and factors described include initial Glasgow Coma Scale score, Revised Trauma Score, the Disability Rating Scale, Functional Independence Measure, levels of cognitive functioning, patient demographics, length of stay, hospital charges, and discharge disposition. ⋯ The remaining 38% were discharged to programs providing varying levels of care depending upon their level of functioning and care needs. Patients sustaining severe injuries following gunshot wound(s) to the head have high early mortality. Survivors able to participate in an inpatient rehabilitation program have good potential for functional improvement.