Journal of neurotrauma
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Journal of neurotrauma · Dec 2009
Both hypoxemia and extreme hyperoxemia may be detrimental in patients with severe traumatic brain injury.
An association between hypoxemia and poor outcomes from traumatic brain injury (TBI) is well documented. However, it is unclear whether hyperoxygenation is beneficial. This registry-based analysis explores the relationship between early hypoxemia and hyperoxemia on outcome from moderate-to-severe TBI. ⋯ Logistic regression revealed an optimal Po(2) range (110-487 mm Hg), with an independent association observed between decreased survival and both hypoxemia (OR 0.54; 95% CI 0.42, 0.69; p < 0.001) and extreme hyperoxemia (OR 0.50; 95% CI 0.36, 0.71; p < 0.001). The association between hypoxemia and extreme hyperoxemia and worse outcomes was also present with use of "good outcomes" as the outcome variable (discharge to home, rehabilitation, jail, or psychiatric facility, or leaving against medical advice). We conclude that both hypoxemia and extreme hyperoxemia are associated with increased mortality and a decrease in good outcomes among TBI patients.
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Journal of neurotrauma · Dec 2009
Randomized Controlled Trial Multicenter StudySafety and tolerability of cyclosporin a in severe traumatic brain injury patients: results from a prospective randomized trial.
Cyclosporin A (CsA) has recently been proposed for use in the early phase after traumatic brain injury (TBI), for its ability to preserve mitochondrial integrity in experimental brain injury models, and thereby provide improved behavioral outcomes as well as significant histological protection. The aim of this prospective, randomized, double-blind, dual-center, placebo-controlled trial was to evaluate the safety, tolerability, and pharmacokinetics of a single intravenous infusion of CsA in patients with severe TBI. Fifty adult severe TBI patients were enrolled over a 22-month period. ⋯ There were no significant differences in other mean laboratory values, or in the incidence of AEs at any other measured time point. Also, no significant difference was demonstrated for neurological outcome. Based on these results, we report a good safety profile of CsA infusion when given at the chosen dose of 5 mg/kg, infused over 24 h, during the early phase after severe head injury in humans, with the aim of neuroprotection.
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Journal of neurotrauma · Dec 2009
ReviewTreatment for depression after traumatic brain injury: a systematic review.
The aim of this systematic review was to critically evaluate the evidence on interventions for depression following traumatic brain injury (TBI) and provide recommendations for clinical practice and future research. We reviewed pharmacological, other biological, psychotherapeutic, and rehabilitation interventions for depression following TBI from the following data sources: PubMed, CINAHL, PsycINFO, ProQuest, Web of Science, and Google Scholar. We included studies written in English published since 1980 investigating depression and depressive symptomatology in adults with TBI; 658 articles were identified. ⋯ This systematic review documents that there is a paucity of randomized controlled trials for depression following TBI. Serotonergic antidepressants and cognitive behavioral interventions appear to have the best preliminary evidence for treating depression following TBI. More research is needed to provide evidence-based treatment recommendations for depression following TBI.
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Journal of neurotrauma · Dec 2009
ReviewAdvances in sport concussion assessment: from behavioral to brain imaging measures.
Given that the incidence of sports-related concussion is considered to have reached epidemic proportions, in the past 15 years we have witnessed an explosion of research in this field. The purpose of the current review is to compare the results provided by the different assessment tools used in the scientific literature in order to gain a better understanding of the sequelae and recovery following a concussion. Until recently, the bulk of the has literature focused on the immediate outcome in the hours and days post-injury as a means to plan the safest return-to-play strategy. ⋯ This is consistent with findings that symptom severity, neuropsychological function, and postural stability do not appear to be related or affected to the same degree after a concussion. Furthermore, recent evidence from brain imaging, including event-related potentials and functional and metabolic imaging, suggest abnormalities in the electrical responses, metabolic balance, and oxygen consumption of neurons that persist several months after the incident. We explain this apparent discrepancy in recovery by suggesting an initial and rapid phase of functional recovery driven by compensatory mechanisms and brain plasticity, which is followed by a prolonged neuronal recovery period during which subtle deficits in brain functioning are present but not apparent to standard clinical assessment tools.
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Journal of neurotrauma · Dec 2009
The Relationship between age, injury severity, and MRI findings after traumatic brain injury.
Age and injury severity are among the most significant predictors of outcome after traumatic brain injury (TBI). However, only a few studies have investigated the association between, age, injury severity, and the extent of brain damage in TBI. The purpose of this study was to investigate the association between age, measures of injury severity, and brain lesion volumes, as well as viable brain volumes, following TBI. ⋯ Older age was also associated with smaller viable grey matter volumes in most neo-cortical brain regions, while longer PTA was associated with smaller viable white matter volumes in most brain regions. The results suggest that older age worsens the impact of TBI on the brain. They also indicate the validity of duration of PTA as a measure of injury severity that is not just related to one particular injury location.