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11 results

Management of Moderate or Severe Traumatic Brain Injury

Management of Moderate or Severe Traumatic Brain Injury
  • Saeed Kayhanian, Erta Beqiri, Ari Ercole, Adel Helmy
  • Coming soon
  • Expected online publication date:
    May 2025
    Print publication:
    31 May 2025
  • The management of patients with moderate and severe traumatic brain injury (TBI) is centred on the intensive care management to limit the extent of secondary injury to the brain, following the primary trauma. This management aims to optimise the homeostatic environment of the brain after injury and can be guided by multi-modality monitoring, including intracranial pressure (ICP) monitoring. This management often follows a tiered approach to introducing more aggressive interventions to correct physiology, based on evidence for ongoing secondary injury, such as raised ICP. The balance between risk and benefit for these interventions for individual patients is difficult, particularly in the absence of high quality randomised trials for many interventions in this area. In this Element, the authors outline both the approach to intensive care management of moderate and severe TBI, as well as the evidence base available for the interventions discussed.

  • Guidelines for Data Acquisition, Quality and Curation for Observational Research Designs (DAQCORD)

  • Ari Ercole, Vibeke Brinck, Pradeep George, Ramona Hicks, Jilske Huijben, Michael Jarrett, Mary Vassar, Lindsay Wilson, the DAQCORD collaborators
  • Journal:
    Journal of Clinical and Translational Science / Volume 4 / Issue 4 / August 2020
    Published online by Cambridge University Press:
    13 March 2020, pp. 354-359
    • Article
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      • Open access
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  • Background:

    High-quality data are critical to the entire scientific enterprise, yet the complexity and effort involved in data curation are vastly under-appreciated. This is especially true for large observational, clinical studies because of the amount of multimodal data that is captured and the opportunity for addressing numerous research questions through analysis, either alone or in combination with other data sets. However, a lack of details concerning data curation methods can result in unresolved questions about the robustness of the data, its utility for addressing specific research questions or hypotheses and how to interpret the results. We aimed to develop a framework for the design, documentation and reporting of data curation methods in order to advance the scientific rigour, reproducibility and analysis of the data.

    Methods:

    Forty-six experts participated in a modified Delphi process to reach consensus on indicators of data curation that could be used in the design and reporting of studies.

    Results:

    We identified 46 indicators that are applicable to the design, training/testing, run time and post-collection phases of studies.

    Conclusion:

    The Data Acquisition, Quality and Curation for Observational Research Designs (DAQCORD) Guidelines are the first comprehensive set of data quality indicators for large observational studies. They were developed around the needs of neuroscience projects, but we believe they are relevant and generalisable, in whole or in part, to other fields of health research, and also to smaller observational studies and preclinical research. The DAQCORD Guidelines provide a framework for achieving high-quality data; a cornerstone of health research.

  • Chapter 6 - Physics and measurement

  • Edited by Jane Sturgess, Justin Davies, Kamen Valchanov
  • Book:
    A Surgeon's Guide to Anaesthesia and Peri-operative Care
    Published online:
    05 July 2014
    Print publication:
    05 June 2014, pp 63-76

  • Summary

    Heat and temperature

    Temperature control is clinically important. Peri-operative hypothermia, in particular, carries a significant morbidity and surgical patients are at particular risk from operative heat loss combined with impaired heat conservation caused by anaesthesia. Furthermore, effective re-warming of patients that have been allowed to become cold can be very difficult. Careful pre-operative and intra-operative management can avoid this if the mechanisms of heat loss and redistribution within the body are appreciated.

    Measuring heat and temperature

    Heat is a form of energy. It arises from the random jostling motion of the particles that make up the matter from which everything is made. The amount of thermal movement is measured by the concept of temperature; objects with little thermal energy having a low temperature. The Celsius/centigrade scale is commonly used in clinical practice and is defined in terms of the freezing (0oC) and boiling (100oC) points of water at standard atmospheric pressure. The SI unit of temperature, however, is the kelvin where 0 K is defined as the temperature at which thermal disorder ceases (absolute zero). A change in temperature of 1oC and 1 K are defined to be the same magnitude so that absolute zero turns out to be equal to -273.15oC.

  • 6 - Cerebral oxygenation

  • from Section 2 - Monitoring and imaging
  • Edited by Basil F. Matta, David K. Menon, Martin Smith
  • Book:
    Core Topics in Neuroanaesthesia and Neurointensive Care
    Published online:
    05 December 2011
    Print publication:
    13 October 2011, pp 72-84

  • Summary

    A number of technologies aimed at detecting oxygen supply/demand imbalance have been developed of which jugular bulb oximetry is the most mature. More recently, near-infrared spectroscopy and direct brain tissue oxygen measurement have become clinically available. The brain extracts oxygen from arterial blood at a rate to supply its global metabolic requirements leaving an oxygen-poor venous effluent. Jugular venous oxygenation can be measured intermittently by serial blood sampling or continuously by fibre-optic oximetry. Jugular bulb oximetry can be used to detect disorders of both cerebral autoregulation and carbon dioxide reactivity. Cerebral oxygenation has been studied by jugular bulb cannulation during aneurysm clipping surgery. Jugular venous saturation has been studied as a potential prognostic marker in comatose patients in which spontaneous circulation has been restored after cardiac arrest. Experience with brain tissue oxygenation microsensors is increasing and clearly these provide a very direct measurement of tissue metabolism.

  • 21 - Traumatic brain injury

  • from Section 4 - Neurointensive care
  • Edited by Basil F. Matta, David K. Menon, Martin Smith
  • Book:
    Core Topics in Neuroanaesthesia and Neurointensive Care
    Published online:
    05 December 2011
    Print publication:
    13 October 2011, pp 315-340

  • Summary

    The risk of morbidity/mortality exists with any surgical/ anaesthetic procedure, but the risk to the central nervous system may be compounded in a patient undergoing a major neurosurgical procedure. The purpose of the pre-operative assessment includes the identification of modifiable risk factors, optimization of the patient's condition, explanation of the risks and formulating the best possible anaesthetic plan for the patient. The general physical examination should focus on the patient's level of consciousness, degree of neurological impairment, mental status, nutrition and vital parameters for baseline. Focused neurological assessment and careful documentation allow the establishment of baseline status and facilitate anaesthetic planning, as well as anticipation of potential perioperative complications. The risk of perioperative respiratory complications is increased in the presence of pre-existing obstructive or restrictive pulmonary disease. Patients at risk of aspiration include those with full stomachs, delayed gastric emptying, bowel obstruction, and gastro-oesophageal reflux.