Background Traumatic brain injury （TBI） is a heterogeneous condition that can lead to critical LLLness-related corticosteroid insufficiency （CIRCI） causing a high mortality and morbidity.Glucocorticoids were widel...Background Traumatic brain injury （TBI） is a heterogeneous condition that can lead to critical LLLness-related corticosteroid insufficiency （CIRCI） causing a high mortality and morbidity.Glucocorticoids were widely used in the clinical management of TBI,but their benefit has been challenged in some studies and their efficacy,especially for treating CIRCI in TBI patients,remains unclear.Methods We conducted a meta-analysis of published data to determine if the controversy is related to clinical dosing and timing of glucocorticoids （GCs） application.We analyzed published reports in four databases （MEDLINE,EMBASE,the Cochrane Controlled Trials Register,and CBMdisc）.The published data were stratified into not only low-and high-dose GCs group but also short-and long-term GCs group to compare their effectiveness in improving TBI outcomes.Results We totally identified 16 reports.For low-dose patients,the pooled relative risks （RRs） for two clinical outcomes of death or a combination of death and severe disability were 0.95 （95% confidence interval （CI）：0.80 to 1.13） and 0.95 （95% CI：0.83 to 1.09）,respectively.The risks for infection and gastrointestinal bleeding were 0.85 （95% CI：0.50 to 1.45） and 0.64 （95% Cl：0.15 to 2.70）,respectively.For high-dose group,the pooled RR of death is 1.14 （95% Cl：1.06 to 1.21）.The pooled RRs for infection and gastrointestinal bleeding for the high-dose patients were 1.04 （95% CI：0.93 to 1.15） and 1.26 （95% CI：0.92 to 1.75）,respectively.For long-term use group,the pooled RRs for two clinical outcomes of death or a combination of death and severe disability were 0.98 （95% CI：0.87 to 1.12） and 1.00 （95% CI：0.90 to 1.11）,respectively.The risks for infection and gastrointestinal bleeding were 0.88 （95% CI：0.71 to 1.11） and 0.96 （95% CI：0.35 to 2.66）,respectively.For short-term use group,the pooled RR of death is 1.15 （95% CI：1.07 to 1.23）,and importantly the effects on infections were beneficial in 展开更多
Traumatic brain injury(TBI) is a major cause of death and disability in children. Severe TBI is a leading cause of death and often leads to life changing disabilities in survivors. The modern management of severe TBI ...Traumatic brain injury(TBI) is a major cause of death and disability in children. Severe TBI is a leading cause of death and often leads to life changing disabilities in survivors. The modern management of severe TBI in children on intensivecare unit focuses on preventing secondary brain injury to improve outcome. Standard neuroprotective measures are based on management of intracranial pressure(ICP) and cerebral perfusion pressure(CPP) to optimize the cerebral blood flow and oxygenation, with the intention to avoid and minimise secondary brain injury. In this article, we review the current trends in management of severe TBI in children, detailing the general and specific measures followed to achieve the desired ICP and CPP goals. We discuss the often limited evidence for these therapeutic interventions in children, extrapolation of data from adults, and current recommendation from paediatric guidelines. We also review the recent advances in understanding the intracranial physiology and neuroprotective therapies, the current research focus on advanced and multi-modal neuromonitoring, and potential new therapeutic and prognostic targets.展开更多
Strong evidence showed that fever after traumatic brain injury TBI is associated with increased mortality. In this study, we tried to evaluate the role of Bromocriptine in central hyperthermia in patients with severe ...Strong evidence showed that fever after traumatic brain injury TBI is associated with increased mortality. In this study, we tried to evaluate the role of Bromocriptine in central hyperthermia in patients with severe TBI. This prospective controlled study was conducted on 50 severe TBI patients who admitted to the critical care department and confirmed on Computed Tomography (CT) of the brain and GCS of less than 9 at admission. Then, they were randomly assigned into 2 groups. Bromocriptine group (25) received bromocriptine 7.5 mg/day during 24 hours from admission through a naso-gastric (NG) feeding tube. Control group (25) received conventional treatment only. Temperature was measured every 2 hours. The antipyretic measures used were the same across all patients enrolled. The primary outcome was number of patients diagnosed with central hyperthermia. After the discharge of all patients, there was a statistically significant difference between the 2 groups in number of patients diagnosed with central hyperthermia (6 (24%) in bromocriptine group Vs 18 (72%) in control, p = 0.002). There were no differences in hospital length of stay (p = 0.904) or mortality (p = 0.393). Early administration of bromocriptine in severe TBI may be associated with lower incidence of central hyperthermia with no effect on length of stay or mortality.展开更多
Calcitonin gene-related peptide（CGRP） has been implicated in multiple functions across many bioprocesses; however, whether CGRP is associated with severe traumatic brain injury（TBI） remains poorly understood. In t...Calcitonin gene-related peptide（CGRP） has been implicated in multiple functions across many bioprocesses; however, whether CGRP is associated with severe traumatic brain injury（TBI） remains poorly understood. In this study, 96 adult patients with TBI（enrolled from September 2015 to December 2016） were divided into a mild/moderate TBI group（36 males and 25 females, aged 38 ± 13 years） and severe TBI group（22 males and 13 females, aged 38 ± 11 years） according to Glasgow Coma Scale scores. In addition, 25 healthy individuals were selected as controls（15 males and 10 females, aged 39 ± 13 years）. Radioimmunoassay was used to detect serum levels of CGRP and endothelin-1 at admission and at 12, 24, 48, 72 hours, and 7 days after admission. CGRP levels were remarkably lower, but endothelin-1 levels were obviously higher in the severe TBI group compared with mild/moderate TBI and control groups. Levels of CGRP were remarkably lower, but endothelin-1 levels were obviously higher in deceased patients compared with patients who survived. Survival analysis and logistic regression showed that both CGRP and endothelin-1 levels were associated with patient mortality, with each serving as an independent risk factor for 6-month mortality of severe TBI patients. Moreover, TBI patients with lower serum CGRP levels had a higher risk of death. Thus, our retrospective analysis demonstrates the potential utility of CGRP as a new biomarker, monitoring method, and therapeutic target for TBI.展开更多
Hypothalamic-pituitary-adrenal axis dysfunction may lead to the occurrence of critical illness-related corticosteroid insufficiency.Critical illness-related corticosteroid insufficiency can easily occur after traumati...Hypothalamic-pituitary-adrenal axis dysfunction may lead to the occurrence of critical illness-related corticosteroid insufficiency.Critical illness-related corticosteroid insufficiency can easily occur after traumatic brain injury,but few studies have examined this occurrence.A multicenter,prospective,cohort study was performed to evaluate the function of the hypothalamic-pituitary-adrenal axis and the incidence of critical illness-related corticosteroid insufficiency during the sub-acute phase of traumatic brain injury.One hundred and forty patients with acute traumatic brain injury were enrolled from the neurosurgical departments of three tertiary-level hospitals in China,and the critical illness-related corticosteroid insufficiency incidence,critical-illness-related corticosteroid insufficiency-related risk factors,complications,and 28-day mortality among these patients was recorded.Critical illness-related corticosteroid insufficiency was diagnosed in patients with plasma total cortisol levels less than 10μg/dL(275.9 nM)on post-injury day 4 or when serum cortisol was insufficiently suppressed(less than 50%)during a dexamethasone suppression test on post-injury day 5.The results demonstrated that critical illness-related corticosteroid insufficiency occurred during the sub-acute phase of traumatic brain injury in 5.6%of patients with mild injury,22.5%of patients with moderate injury,and 52.2%of patients with severe injury.Traumatic brain injury-induced critical illness-related corticosteroid insufficiency was strongly correlated to injury severity during the sub-acute stage of traumatic brain injury.Traumatic brain injury patients with critical illness-related corticosteroid insufficiency frequently presented with hemorrhagic cerebral contusions,diffuse axonal injury,brain herniation,and hypotension.Differences in the incidence of hospital-acquired pneumonia,gastrointestinal bleeding,and 28-day mortality were observed between patients with and without critical illness-related corticosteroid insufficiency dur展开更多
目的分析高压氧疗法应用于重症脑外伤患者康复治疗期间的疗效。方法方便选取2020年6月—2023年6月青岛市城阳区人民医院收治的98例重症脑外伤患者,根据治疗方案的不同分为两组,每组49例,对照组接受常规康复治疗,研究组在对照组基础上加...目的分析高压氧疗法应用于重症脑外伤患者康复治疗期间的疗效。方法方便选取2020年6月—2023年6月青岛市城阳区人民医院收治的98例重症脑外伤患者,根据治疗方案的不同分为两组,每组49例,对照组接受常规康复治疗,研究组在对照组基础上加用高压氧治疗,比较两组患者康复治疗效果。结果研究组治疗有效率(97.96%)显著高于对照组(81.63%),差异有统计学意义(χ^(2)=7.127,P<0.05)。治疗前,两组患者神经功能缺损评分比较,差异无统计学意义(P>0.05);治疗后,研究组神经功能缺损评分低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分比较,差异无统计学意义(P>0.05);治疗后,研究组GCS评分高于对照组,差异有统计学意义(P<0.05)。研究组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论重症脑外伤患者在常规康复治疗的基础上予以高压氧治疗,可提升患者的康复速度,改善患者的神经功能,预防并发症的出现,疗效确切。展开更多
基金This work was supported by grants from the National Natural Science Foundation of China （No. 81000533）, the Project of Tianjin Applied Basic and Cutting-edge Technological Research （No. 13JCQNJC10500） and National Key Basic Research Program in China （No. 2005CB522600）. Conflicts of interest： none.
文摘Background Traumatic brain injury （TBI） is a heterogeneous condition that can lead to critical LLLness-related corticosteroid insufficiency （CIRCI） causing a high mortality and morbidity.Glucocorticoids were widely used in the clinical management of TBI,but their benefit has been challenged in some studies and their efficacy,especially for treating CIRCI in TBI patients,remains unclear.Methods We conducted a meta-analysis of published data to determine if the controversy is related to clinical dosing and timing of glucocorticoids （GCs） application.We analyzed published reports in four databases （MEDLINE,EMBASE,the Cochrane Controlled Trials Register,and CBMdisc）.The published data were stratified into not only low-and high-dose GCs group but also short-and long-term GCs group to compare their effectiveness in improving TBI outcomes.Results We totally identified 16 reports.For low-dose patients,the pooled relative risks （RRs） for two clinical outcomes of death or a combination of death and severe disability were 0.95 （95% confidence interval （CI）：0.80 to 1.13） and 0.95 （95% CI：0.83 to 1.09）,respectively.The risks for infection and gastrointestinal bleeding were 0.85 （95% CI：0.50 to 1.45） and 0.64 （95% Cl：0.15 to 2.70）,respectively.For high-dose group,the pooled RR of death is 1.14 （95% Cl：1.06 to 1.21）.The pooled RRs for infection and gastrointestinal bleeding for the high-dose patients were 1.04 （95% CI：0.93 to 1.15） and 1.26 （95% CI：0.92 to 1.75）,respectively.For long-term use group,the pooled RRs for two clinical outcomes of death or a combination of death and severe disability were 0.98 （95% CI：0.87 to 1.12） and 1.00 （95% CI：0.90 to 1.11）,respectively.The risks for infection and gastrointestinal bleeding were 0.88 （95% CI：0.71 to 1.11） and 0.96 （95% CI：0.35 to 2.66）,respectively.For short-term use group,the pooled RR of death is 1.15 （95% CI：1.07 to 1.23）,and importantly the effects on infections were beneficial in
文摘Traumatic brain injury(TBI) is a major cause of death and disability in children. Severe TBI is a leading cause of death and often leads to life changing disabilities in survivors. The modern management of severe TBI in children on intensivecare unit focuses on preventing secondary brain injury to improve outcome. Standard neuroprotective measures are based on management of intracranial pressure(ICP) and cerebral perfusion pressure(CPP) to optimize the cerebral blood flow and oxygenation, with the intention to avoid and minimise secondary brain injury. In this article, we review the current trends in management of severe TBI in children, detailing the general and specific measures followed to achieve the desired ICP and CPP goals. We discuss the often limited evidence for these therapeutic interventions in children, extrapolation of data from adults, and current recommendation from paediatric guidelines. We also review the recent advances in understanding the intracranial physiology and neuroprotective therapies, the current research focus on advanced and multi-modal neuromonitoring, and potential new therapeutic and prognostic targets.
文摘Strong evidence showed that fever after traumatic brain injury TBI is associated with increased mortality. In this study, we tried to evaluate the role of Bromocriptine in central hyperthermia in patients with severe TBI. This prospective controlled study was conducted on 50 severe TBI patients who admitted to the critical care department and confirmed on Computed Tomography (CT) of the brain and GCS of less than 9 at admission. Then, they were randomly assigned into 2 groups. Bromocriptine group (25) received bromocriptine 7.5 mg/day during 24 hours from admission through a naso-gastric (NG) feeding tube. Control group (25) received conventional treatment only. Temperature was measured every 2 hours. The antipyretic measures used were the same across all patients enrolled. The primary outcome was number of patients diagnosed with central hyperthermia. After the discharge of all patients, there was a statistically significant difference between the 2 groups in number of patients diagnosed with central hyperthermia (6 (24%) in bromocriptine group Vs 18 (72%) in control, p = 0.002). There were no differences in hospital length of stay (p = 0.904) or mortality (p = 0.393). Early administration of bromocriptine in severe TBI may be associated with lower incidence of central hyperthermia with no effect on length of stay or mortality.
文摘Calcitonin gene-related peptide（CGRP） has been implicated in multiple functions across many bioprocesses; however, whether CGRP is associated with severe traumatic brain injury（TBI） remains poorly understood. In this study, 96 adult patients with TBI（enrolled from September 2015 to December 2016） were divided into a mild/moderate TBI group（36 males and 25 females, aged 38 ± 13 years） and severe TBI group（22 males and 13 females, aged 38 ± 11 years） according to Glasgow Coma Scale scores. In addition, 25 healthy individuals were selected as controls（15 males and 10 females, aged 39 ± 13 years）. Radioimmunoassay was used to detect serum levels of CGRP and endothelin-1 at admission and at 12, 24, 48, 72 hours, and 7 days after admission. CGRP levels were remarkably lower, but endothelin-1 levels were obviously higher in the severe TBI group compared with mild/moderate TBI and control groups. Levels of CGRP were remarkably lower, but endothelin-1 levels were obviously higher in deceased patients compared with patients who survived. Survival analysis and logistic regression showed that both CGRP and endothelin-1 levels were associated with patient mortality, with each serving as an independent risk factor for 6-month mortality of severe TBI patients. Moreover, TBI patients with lower serum CGRP levels had a higher risk of death. Thus, our retrospective analysis demonstrates the potential utility of CGRP as a new biomarker, monitoring method, and therapeutic target for TBI.
基金supported by the National Natural Science Foundation of China,No.81671902(to XC)81501704(to YC)+3 种基金the Project of Tianjin Applied Basic and Cutting-edge Technological Research of China,No.17JCYBJC25200(to XC)15JCQNJC44900(to YC)Tianjin Health Care Elite Prominent Young Doctor Development Program(to XC)the Young and Middle-aged Backbone Innovative Talent Program(to XC)
文摘Hypothalamic-pituitary-adrenal axis dysfunction may lead to the occurrence of critical illness-related corticosteroid insufficiency.Critical illness-related corticosteroid insufficiency can easily occur after traumatic brain injury,but few studies have examined this occurrence.A multicenter,prospective,cohort study was performed to evaluate the function of the hypothalamic-pituitary-adrenal axis and the incidence of critical illness-related corticosteroid insufficiency during the sub-acute phase of traumatic brain injury.One hundred and forty patients with acute traumatic brain injury were enrolled from the neurosurgical departments of three tertiary-level hospitals in China,and the critical illness-related corticosteroid insufficiency incidence,critical-illness-related corticosteroid insufficiency-related risk factors,complications,and 28-day mortality among these patients was recorded.Critical illness-related corticosteroid insufficiency was diagnosed in patients with plasma total cortisol levels less than 10μg/dL(275.9 nM)on post-injury day 4 or when serum cortisol was insufficiently suppressed(less than 50%)during a dexamethasone suppression test on post-injury day 5.The results demonstrated that critical illness-related corticosteroid insufficiency occurred during the sub-acute phase of traumatic brain injury in 5.6%of patients with mild injury,22.5%of patients with moderate injury,and 52.2%of patients with severe injury.Traumatic brain injury-induced critical illness-related corticosteroid insufficiency was strongly correlated to injury severity during the sub-acute stage of traumatic brain injury.Traumatic brain injury patients with critical illness-related corticosteroid insufficiency frequently presented with hemorrhagic cerebral contusions,diffuse axonal injury,brain herniation,and hypotension.Differences in the incidence of hospital-acquired pneumonia,gastrointestinal bleeding,and 28-day mortality were observed between patients with and without critical illness-related corticosteroid insufficiency dur
文摘目的分析高压氧疗法应用于重症脑外伤患者康复治疗期间的疗效。方法方便选取2020年6月—2023年6月青岛市城阳区人民医院收治的98例重症脑外伤患者,根据治疗方案的不同分为两组,每组49例,对照组接受常规康复治疗,研究组在对照组基础上加用高压氧治疗,比较两组患者康复治疗效果。结果研究组治疗有效率(97.96%)显著高于对照组(81.63%),差异有统计学意义(χ^(2)=7.127,P<0.05)。治疗前,两组患者神经功能缺损评分比较,差异无统计学意义(P>0.05);治疗后,研究组神经功能缺损评分低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分比较,差异无统计学意义(P>0.05);治疗后,研究组GCS评分高于对照组,差异有统计学意义(P<0.05)。研究组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论重症脑外伤患者在常规康复治疗的基础上予以高压氧治疗,可提升患者的康复速度,改善患者的神经功能,预防并发症的出现,疗效确切。
