Journal of neurotrauma
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Journal of neurotrauma · Jun 2000
Review Practice Guideline GuidelineThe Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Role of steroids.
The majority of available evidence indicates that steroids do not improve outcome or lower ICP in severely head-injured patients. The routine use of steroids is not recommended for these purposes.
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Journal of neurotrauma · Jun 2000
Review Practice Guideline GuidelineThe Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Nutrition.
Data show that starved head-injured patients lose sufficient nitrogen to reduce weight by 15% per week. Class II data show that 100-140% replacement of resting metabolism expenditure with 15-20% nitrogen calories reduces nitrogen loss. Data in non-head injured patients show that a 30% weight loss increased mortality rate. ⋯ The data strongly support feeding at least by the end of the first week. It has not been established that any method of feeding is better than another or that early feeding prior to 7 days improves outcome. Based on the level of nitrogen wasting documented in head-injured patients and the nitrogen sparing effect of feeding, it is a guideline that full nutritional replacement be instituted by day 7.
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Journal of neurotrauma · Jun 2000
Review Practice Guideline GuidelineThe Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Indications for intracranial pressure monitoring.
ICP monitoring per se has never been subjected to a prospective randomized clinical trial (PRCT) to establish its efficacy (or lack thereof) in improving outcome from severe head injury. Hence, there are insufficient data to support its use as a standard. However, there is a large body of published clinical experience that indicates that ICP monitoring (1) helps in the earlier detection of intracranial mass lesions, (2) can limit the indiscriminate use of therapies to control ICP which themselves can be potentially harmful, (3) can reduce ICP by CSF drainage and thus improve cerebral perfusion, (4) helps in determining prognosis, and (5) may improve outcome. ⋯ ICP monitoring in patients with a normal CT scan with two or more of these risk factors is suggested as a guideline. Routine ICP monitoring is not indicated in patients with mild or moderate head injury. However, it may be undertaken in certain conscious patients with traumatic mass lesions at the discretion of the treating physician.
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Journal of neurotrauma · Jun 2000
Review Practice Guideline GuidelineThe Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Use of mannitol.
There are two "class 1" studies, and one "class 2" study, and a large body of "Class 3" data, which can be used to support mannitol. The evidence supporting use of mannitol for ICP control is sufficiently strong to warrant guideline status. ⋯ Serum osmolalities >320 mOsm and hypovolemia should be avoided. There is some data to suggest that bolus administration is preferable to continuous infusion.
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Journal of neurotrauma · Jun 2000
Review Practice Guideline GuidelineThe Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Pupillary diameter and light reflex.
The pupillary diameter and the pupilloconstrictor light reflex are the two parameters that have been studied extensively in relation to prognosis. Accurate measurement of pupil diameter or the constrictor response or the duration of the response has not been performed in studies on traumatic brain-injured individuals--for lack of a standardized measuring procedure. The following is recommended: 1. ⋯ Hypotension and hypoxia should be corrected before assessing pupils for prognosis. 7. Direct orbital trauma should be excluded. 8. Pupils should be reassessed after surgical evacuation of intracranial hematomas.