Articles: brain-injuries.
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Journal of neurosurgery · Mar 1993
Randomized Controlled Trial Clinical TrialImproving the outcome of severe head injury with the oxygen radical scavenger polyethylene glycol-conjugated superoxide dismutase: a phase II trial.
Formation of the oxygen radical superoxide anion is one of the final events of several metabolic pathways in the cascade that leads to delayed neuronal death after traumatic or ischemic brain injury. In the laboratory, scavenging of the superoxide anion with native superoxide dismutase (SOD) or polyethylene glycol (PEG)-conjugated SOD (PEG-SOD) has been shown to be beneficial in several types of traumatic and ischemic injury. Accordingly, PEG-SOD was utilized in a randomized controlled Phase II trial to evaluate its safety and efficacy in severely head-injured patients with a Glasgow Coma Scale score of 8 or less. ⋯ Differences in outcome between the placebo group and either of the other two dosage groups were not statistically significant. It is concluded that PEG-SOD was generally well tolerated and appears promising in improving outcome after severe head injury. A larger, multicenter, Phase III trial, using a higher dose (20,000 U/kg) compared to placebo and to 10,000 U/kg of PEG-SOD is planned.
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The combined cardiovascular effects of hemorrhagic shock and mechanical brain injury were modeled in five groups of pigs. Standard and hypertonic saline resuscitation of hypotension were evaluated. Changes in mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), intracranial pressure (ICP), and brain water were measured. ⋯ Volumes of saline required to restore blood pressure were large (> 6 L in 3 hours). 1.8% saline produced less rise in ICP than 0.9% saline but was less effective in restoring blood pressure. Brain edema was not decreased with 1.8% saline. Brain injury altered vascular compensation to hemorrhage and made accepted resuscitative measures ineffective.
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An overview is presented on historical and multivariate aspects of cerebral hemometabolism. This involves a full multivariate approach, from blood pressure to cerebral metabolism. ⋯ A generic proposition is made for studies of truly normal cerebral hemometabolism in children, for subsequent clinical applications. Another proposition is made for multivariate cerebral hemometabolic monitoring, in a broad variety of circumstances of predominantly global changes in intracranial dynamics, both in animal and clinical research.
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An estimated 60,000 patients with severe head injury reach the Emergency Department alive each year; 50% of these patients have significant elevations in intracranial pressure at or shortly after arrival. Aggressive emergency department management with particular attention to airway management, control of intracranial pressure, and proper use of radiographic studies is crucial to successful neurologic recovery.
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Critical care medicine · Feb 1993
Comparative StudyAutonomic cardiovascular state after severe brain injury and brain death in children.
To study and compare the autonomic cardiovascular state of children after severe brain injury and brain death. ⋯ Our results support the concept of a damaged sympathetic cardiovascular system in severe brain injury and complete interruption of the autonomic cardiovascular pathways in brain death. Since determination of brain death may be difficult, our findings have implications for corroborating brain death using autonomic cardiovascular testing.