RESUMEN
The patient with head trauma is a challenge for the emergency physician and for the neurosurgeon. Currently traumatic brain injury constitutes a public health problem. Knowledge of the various supportive therapeutic strategies in the pre-hospital and pre-operative stages is essential for optimal care. The immediate rapid infusion of large volumes of crystalloids to restore blood volume and blood pressure is now the standard treatment of patients with combined traumatic brain injury [TBI] and hemorrhagic shock [HS]. The fluid in patients with brain trauma and especially in patients with brain injury is a critical issue. In this context we present a review of the literature about the history, physiology of current fluid preparations, and a discussion regarding the use of fluid therapy in traumatic brain injury and decompressive craniectomy
RESUMEN
Objective: To determine the effects of glycemic level on outcome patients with traumatic brain injury
Methods: From September 2010 to December 2012, all medical records of adult patients with TBI admitted to the Emergency Room of Laura Daniela Clinic in Valledupar City, Colombia, South America were enrolled. Both genders between 18 and 85 years who referred during the first 48 hours after trauma, and their glucose level was determined in the first 24 hours of admission were included. Adults older than 85 years, with absence of Glasgow Coma Scale [GCS] score and a brain Computerized Tomography [CT] scans were excluded. The cut-off value was considered 200 mg/dL to define hyperglycemia. Final GCS, hospital admission duration and complications were compared between normoglycemic and hyperglycemic patients
Results: Totally 217 patients were identified with TBI. Considering exclusion criteria, 89 patients remained for analysis. The mean age was 43.0 +/- 19.6 years, the mean time of remission was 5.9 +/- 9.4 hours, the mean GCS on admission was 10.5 +/- 3.6 and the mean blood glucose level in the first 24 hours was 138.1 +/- 59.4 mg/dL. Hyperglycemia was present in 13.5% of patients. The most common lesions presented by patients with TBI were fractures [22.5%], hematoma [18.3%], cerebral edema [18.3%] and cerebral contusion [16.2%]. Most of patients without a high glucose level at admission were managed only medically, whereas surgical treatment was more frequent in patients with hyperglycemia [p=0.042]. Hyperglycemia was associated with higher complication [p=0.019] and mortality rate [p=0.039]. GCS was negatively associated with on admission glucose level [r=0.11; p=0.46]
Conclusion: Hyperglycemia in the first 24-hours of TBI is associated with higher rate of surgical intervention, higher complication and mortality rates. So hyperglycemia handling is critical to the outcome of patients with traumatic brain injury