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CURRENT CONTROVERSIES IN THE MANAGEMENT OF PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY
Author(s) -
Adamides Alexios A.,
Winter Craig D.,
Lewis Philip M.,
Cooper D. James,
Kossmann Thomas,
Rosenfeld Jeffrey V.
Publication year - 2006
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2006.03674.x
Subject(s) - medicine , traumatic brain injury , hyperventilation , decompressive craniectomy , intensive care medicine , intracranial pressure , cerebral perfusion pressure , psychological intervention , randomized controlled trial , hypothermia , anesthesia , surgery , cerebral blood flow , psychiatry
Background: Traumatic brain injury is a major cause of mortality and morbidity, particularly among young men. The efficacy and safety of most of the interventions used in the management of patients with traumatic brain injury remain unproven. Examples include the ‘cerebral perfusion pressure‐targeted’ and ‘volume‐targeted’ management strategies for optimizing cerebrovascular haemodynamics and specific interventions, such as hyperventilation, osmotherapy, cerebrospinal fluid drainage, barbiturates, decompressive craniectomy, therapeutic hypothermia, normobaric hyperoxia and hyperbaric oxygen therapy. Methods: A review of the literature was performed to examine the evidence base behind each intervention. Results: There is no class I evidence to support the routine use of any of the therapies examined. Conclusion: Well‐designed, large, randomized controlled trials are needed to determine therapies that are safe and effective from those that are ineffective or harmful.