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Respiratory management in patients with acute severe brain injury is an important part of the integrated critical management.A series of special pathophysiological changes and clinical manifestations after brain injury make it different from non-central nervous system diseases.Lung protective ventilation strategy and evidence from clinical trials have challenged the traditional view of respiratory management:hypocarbonemia and low PEEP strategy are no longer routine options for respiratory management in patients with brain injury,but respiratory management still needs to follow the principle of "avoiding secondary injury".Multimodal neuromonitoring shows good prospects,which is helpful to achieve the precision of respiratory management by optimizing the targets of the management of intracranial pressure,cerebral perfusion and cerebral oxygen metabolism.
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Objective To investigate the curative effect of acute severe brain injury complicated ARDS, Methods 31 patients who had acute severe brain injury complicated ARDS were divided into two groups:A group was early discovery of ARDS and given treatment.B group was late discovery of ARDS and treated late.Then the curative effects were compared.Results A group was significantly higher than B group in blood gas analysis(P
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OBJECTIVE:To analyze the clinical efficacy of edaravone combined with Xingnaojing in the treatment of acute severe head injury.METHODS:72 patients with acute severe brain injury were collected from Nov.2008 to Nov.2009 and randomly divided into 2 groups.Treatment group were treated with edaravone and Xingnaojing and control group received edaravone alone.14 days after treatment,APACHE-Ⅱ and GCS score were collected.The overall efficacies of 2 groups were evaluated three months after suffering from injury.RESULTS:The GCS score of treatment group was increased while APACHE-Ⅱ score was decreased,there was statistical significance in difference between 2 groups(P
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Objective To evaluate whether the strict control of serum glucose can improve the prognosis for cerebral metabolism and nervous system of these patients with severe head injury.Methods A total of 46 severe head injury patients were randomly assigned to receive intensive insulin therapy or routine therapy,titrating serum glucose levels at 4-6 mmol/L and less than 11 mmol/L respectively.All patients were treated according to neurosurgical intensive care routine including monitoring intracranial pressure(ICP).Lactate and pH value of cerebrospinal fluid(CSF) were tested continually in a week after admission,while Glasgow Coma Scale(GCS) scores were appealed for evaluating neurological function in the two groups.Results In comparison with control group,lactate concentrations and intracranial pressure significantly decreased after insulin treatment as well as the marked elevation of GCS scores.There was no difference in pH values of CSF between the two groups.Intensive insulin therapy also reduced the ICU days and hospital stay.Conclusion As a valuable protocol for glucose management,intensive insulin therapy ameliorates the accumulation of lactate in the ischemic brain tissue after injury,depress ICP during oedema cresttime and improve neurological outcomes.