Treatments and outcome, the point in head trauma

Annales Françaises D'anesthèsie Et De Rèanimation
B Vigué, C Ract

Abstract

When a severe traumatic brain-injured patient arrives to hospital, fear of failure and definite opinions about the outcome modify early care and provoke self-fulfilling prophecies. It is obvious that working on prognosis is not only useful to inform relatives but also permits to maintain a high level of care, key for a better outcome. Mortality is high (40-50%) if deaths in the first days are not excluded. Following guidelines in all cases will permit to decrease the number of preventable death and a decrease in morbidity. Well-defined networks of care leading to specialized centres with multimodal monitoring give best results. However, only 20% of living patients return to their previous life with mild handicap. These unsatisfactory results require intensifying research, notably in early rehabilitation in intensive care unit. Ethic issues should be discussed after few days of care and dialogue with relatives in a defined "window of opportunity". Ideally, we need to find strong and early indicators of outcome to limit fears on presumed handicap. A magnetic resonance imaging (MRI) sequence called diffusion tensor imaging (TDI) permits to visualise traumatic axonal injury. Studies with complex statistical methodology give a good ...Continue Reading

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Citations

Jan 21, 2014·Annales Françaises D'anesthèsie Et De Rèanimation·L Puybasset, R D Stevens

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Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.