Application of optical methods in the monitoring of traumatic brain injury: A review.

We present an overview of the wide range of potential applications of optical methods for monitoring traumatic brain injury. The MEDLINE database was electronically searched with the following search terms: "traumatic brain injury," "head injury," or "head trauma," and "optical methods," "NIRS," "near-infrared spectroscopy," "cerebral oxygenation," or "cerebral oximetry." Original reports concerning human subjects published from January 1980 to June 2015 in English were analyzed. Fifty-four studies met our inclusion criteria. Optical methods have been tested for detection of intracranial lesions, monitoring brain oxygenation, assessment of brain perfusion, and evaluation of cerebral autoregulation or intracellular metabolic processes in the brain. Some studies have also examined the applicability of optical methods during the recovery phase of traumatic brain injury . The limitations of currently available optical methods and promising directions of future development are described in this review. Considering the outstanding technical challenges, the limited number of patients studied, and the mixed results and opinions gathered from other reviews on this subject, we believe that optical methods must remain primarily research tools for the present. More studies are needed to gain confidence in the use of these techniques for neuromonitoring of traumatic brain injury patients.

[Near-infrared spectroscopy for the detection of traumatic intracranial hemorrhage: Feasibility study in a German army field hospital in Afghanistan]. / Nahinfrarotspektroskopie zur Detektion intrakranieller traumatischer Hirnblutungen: Praktikabilitätsstudie in einem Bundeswehrrettungszentrum in Afghanistan.

Traumatic brain injury (TBI) is one of the most common causes of death in ordinary accidents, natural disasters, or warfare. The gold standard for diagnosis of TBI is the CT scan; a delay of diagnostics or medical care is the strongest independent predictor of mortality of TBI patients--particularly in the case of a surgically treatable intracranial hematoma. The proper classification of these patients is of major importance in situations where a CT is not accessible. A portable screening device that uses near-infrared spectroscopy (NIRS) technology allows a preliminary estimate of an intracranial hematoma. This study assessing practicability shows that the use of the device in a military medical rescue center (Kunduz, Afghanistan) is easy to learn and can be repeatedly used even under emergency room conditions. The technique can be applied in penetrating and blunt TBIs in the absence of an immediately available CT scan in rural areas, preclinically, under mass casualty conditions (e.g., in disaster situations) as well as in humanitarian crises or war zones. Nevertheless, further studies to assess the validity of this device are necessary.

B-type natriuretic peptide levels may be elevated in the critically injured trauma patient without congestive heart failure.

BACKGROUND: Rapid diagnosis of congestive heart failure (CHF) is essential to treatment. B-type natriuretic peptide (BNP) is a neurohormone secreted by the heart in response to fluid overload and has been shown to be elevated in medical patients with left ventricular dysfunction. However, BNP has not been evaluated in the critically ill patient with trauma. METHODS: Trauma patients of at least 18 years of age with an expected intensive care unit stay of at least 24 hours were studied. Patients had BNP measurements at admission and at 24 hours and 48 hours. Echocardiography was performed within 48 hours of admission. CHF was determined by echocardiographic findings of systolic or diastolic dysfunction. Elevated BNP levels were defined as those greater than 100 pg/mL. A Fisher's exact test was performed to determine whether a relationship between BNP levels and echocardiographic findings existed. Linear correlation was used to determine whether BNP correlated with echocardiographic findings and initial Glasgow Coma Scores. RESULTS: Fifty patients were included in the analysis. There was no relationship between elevated BNP levels and echocardiographic evidence of CHF (p = 0.149). There was no threshold value above which CHF was present. There were 28 patients with head injuries, and no relationship between BNP levels and CHF could be found (p = 0.432) in this group. CONCLUSION: Our data show no association between BNP and CHF in the critically ill patient with trauma. BNP levels may be elevated in patients with head injuries without echocardiographic evidence of CHF.

[Expression of synaptophysin in experimental diffuse brain injury].

OBJECT: To investigate the changes in the expression_level of synaptophysin following diffuse brain injury (DBI) in rats and to correlate the changes of the synaptophysin expression_level with the post injury time interval. METHODS: Wister rats were used as a DBI model induced by Marmarou method. The changes of synaptophysin immunoreactivity on coronal sections of the rats sampled at different post-injury time intervals were used as a marker. The densitometry of the synaptophysin immunoreactivity was documented by imaging technique and analyzed by SPSS software. RESULTS: The expression level of synaptophysin in DBI rats showed dynamic changes following DBI as well as during the repairing period. CONCLUSION: The changes of synaptophysin level may be used as a marker for estimation of the post injury time interval in DBI.