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Curr Opin Crit Care. 2008 Apr;14(2):129-34. doi: 10.1097/MCC.0b013e3282f63c51.

Treatment of intracranial hypertension.

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1
Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie-Paris 6, Paris, France.

Abstract

PURPOSE OF REVIEW:

The review provides key points and recent advances regarding the treatments of intracranial hypertension as a consequence of traumatic brain injury. The review is based on the pathophysiology of brain edema and draws on the current literature as well as clinical bedside experience.

RECENT FINDINGS:

The review will cite baseline literature and discuss emerging data on cerebral perfusion pressure, sedation, hypothermia, osmotherapy and albumin as treatments of intracranial hypertension in traumatic brain-injured patients.

SUMMARY:

One of the key issues is to consider that traumatic brain injury is more likely a syndrome than a disease. In particular, the presence or absence of a high contusional volume could influence the treatments to be implemented. The use of osmotherapy and/or high cerebral perfusion pressure should be restricted to patients without major contusions. Some physiopathological, experimental and clinical data, however, show that corticosteroids and albumin--therapies that have been proven deleterious if administered systematically--are worth reconsidering for this subgroup of patients. The current Pitié-Salpêtrière algorithm, where treatments are stratified according to their potential side effects, will be added at the end of the review as an example of an integrated strategy.

PMID:
18388673
DOI:
10.1097/MCC.0b013e3282f63c51
[Indexed for MEDLINE]
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