Skip to main content
SpringerLink
Log in

Preclinical Treatment of Patients With Severe Brain Injuries

  • Chapter
Severe Head Injuries

  • 98 Accesses

Abstract

Approximately 50% of patients with head injuries die either at the scene of the accident or on arrival at hospital [1], most of them from secondary insults to the already injured brain. Adequate prehospital care is crucial for these patients. The concept of preventable death was first defined by Van Wagoner [2] in 1961. Jennett and Carlin [3] referred specifically to patients with head injuries and noted that most preventable deaths from head injury are caused by inappropriate prehospital management. As early as 1958 MacIver et al. adressed the problem of prehospital hypoxia [4] and stated that “anoxia is the main cause of death in patients who survive the accident but die at a later stage.” Recognizing that almost one-third of trauma deaths in nondesignated hospitals are preventable [5], the American College of Surgeons [6] and the Joint Section of Trauma of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons have developed [7] criteria for designated (neuro-)trauma centers. Development of these specialized regional trauma centers has contributed enormously to improved survival and outcome for trauma patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  1. Klauber MR, Marshall LF, Toole BM (1985) Cause of decline in head-injured mortality rate in San Diego County. J Neurosurg 62: 528–531.

    Article  PubMed  CAS  Google Scholar 

  2. Van Wagoner FH (1961) Died in hospital: a three-year study of deaths following trauma. J Trauma 1: 401–408.

    Google Scholar 

  3. Jennett B, Carlin J (1978) Preventable mortality and morbidity after head injury. Injury 10: 31–39.

    Article  PubMed  CAS  Google Scholar 

  4. Maclver IN, Frew IJC, Matheson JG (1958) The role of respiratory insufficiency in the mortality of severe head injuries. Lancet 1: 390–393.

    Article  Google Scholar 

  5. Cales RH, Trunkey DD (1985) Preventable trauma deaths: a review of trauma care systems development. JAMA 254:1059–1063.

    Article  PubMed  CAS  Google Scholar 

  6. Committee on Trauma (1986) Hospital and prehospital resources for the care of the injured patient. Bull Am Coll Surg 71: 4–12.

    Google Scholar 

  7. Pitts LH, Ojemann RG, Quest DO (1987) Neurotrauma care and the neurosurgeon: A statement from the Joint Section of Trauma of the AANS and CNS. J Neurosurg 67: 783–785.

    PubMed  CAS  Google Scholar 

  8. Schmidt U, Herlich M, Frame SB et al. (1991) On-scene helicopter transport of the multi-trauma patient - comparison of a German and an American system. J Trauma 31:1038.

    Article  Google Scholar 

  9. Colohan ART, Alves WM, Gross CR et al. (1989) Head injury mortality in two centers with different emergency medical services and intensive care. J Neurosurg 71: 202–207.

    Article  PubMed  CAS  Google Scholar 

  10. Deutscher Verkehrssicherheitsrat, Bayerisches Staatsministerium des Inneren (1985) Not-fallrettung Unterfranken. Zur Wirksamkeit und Wirtschaftlichkeit des Rettungsdienstes. Dokumentation II (Internal publication by the ministry of health).

    Google Scholar 

  11. Jenkins LW, Mosszynski K, Lyeth BF et al. (1989) Increased vulnerability of the mildly traumatized rat brain to cerebral ischemia: the use of controlled secondary ischemia as a research tool to identify common or different mechanisms contributing to mechnical and ischemic brain injury. Brain Res 477: 211–224.

    Article  PubMed  CAS  Google Scholar 

  12. Marshall LF, Becker DP, Bowers SA et al. (1983) The National Traumatic Coma Data Bank. I. Design, purpose, goals, and results. J Neurosurg 59: 276–284.

    Article  PubMed  CAS  Google Scholar 

  13. Chesnut RM, Marshall SB, Piek J et al. (1993) Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir Suppl (Wien) 59:121–125.

    CAS  Google Scholar 

  14. Wahjoepramono EJ, Piek J, Bock WJ (1993) prehospital airway care and control of ventilation in patients with head injuries — a retrospective analysis in 1623 head trauma victims. In: Lorenz R, Brock M, Klinger M (eds) Advances in neurosurgery 21. Springer, Berlin Heidelberg New York, pp 184–187.

    Google Scholar 

  15. Gaab MR and the German GUDHIS Study Group (1995) Ultrahohe Dexamethason-Gabe beim akuten Schädelhirntrauma. Ergebnisse einer prospektiven randomisierten Dop-pelblind-Multicenter-Studie (GUDHIS). Zbl Neurochir 55:135–143.

    Google Scholar 

  16. Marshall LF (ND) Results from the protocol P-2700–0036 (Tirilazad in patients with moderate and severe head injuries), (unpublished).

    Google Scholar 

  17. Miller JD, Sweet RC, Narayan RK et al. (1978) Early insult to the injured brain. JAMA 240: 439–442.

    Article  PubMed  CAS  Google Scholar 

  18. Chesnut RM, Marshall LF, Klauber MR et al. (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34: 216–222.

    Article  PubMed  CAS  Google Scholar 

  19. Wald SL, Shackford SR, Fenwick J (1993) The effect of secondary insults on mortality and long-term disability after severe head injury in a rural region without a trauma system. J Trauma 34: 377–381.

    Article  PubMed  CAS  Google Scholar 

  20. Bowers SA, Marshall LF (1980) Outcome in 200 consecutive cases of severe head injury in San Diego County: a prospective analysis. Neurosurgery 6: 237–242.

    Article  PubMed  CAS  Google Scholar 

  21. Miller JD, Becker DP (1982) Secondary insults to the injured brain. J R Coll Surg Edinb 27: 292–298.

    PubMed  CAS  Google Scholar 

  22. Klauber MR, Marshall LF, Luerssen TG et al. (1989) Determinants of head injury mortality: Importance of the low risk patient. Neurosurgery 24:31–36.

    Article  PubMed  CAS  Google Scholar 

  23. Newfield P, Pitts L, Kaktis J et al. (1980) The influence of shock on mortality after head trauma. Crit Care Med 8: 254.

    Article  Google Scholar 

  24. Piek J, Chesnut RM, Marshall LF et al. (1992) Extracranial complications of severe head injury. J Neurosurg 77: 901–907.

    Article  PubMed  CAS  Google Scholar 

  25. Price DJE, Murray A (1972) Influence of hypoxia and hypotension on recovery from head injury. Injury 3: 218–224.

    Article  PubMed  CAS  Google Scholar 

  26. Rose J, Valtonen S, Jennett B (1977) Avoidable factors contributing to death after head injury. BMJ 21: 615–618.

    Article  Google Scholar 

  27. Chevret S, Hemmer M, Carlet J et al. (1993) Incidence and risk factors of pneumonia acquired in intensive care units. Results from a multicenter prospective study on 996 patients. European Cooperative Group on Nosocomial Pneumonia. Intensive Care Med 19: 256–264.

    Article  PubMed  CAS  Google Scholar 

  28. Singbartl G (1985) Die Bedeutung der präklinischen Notfallversorgung für die Prognose von Patienten mit schwerem Schädel-Hirn-Trauma. Anaesth Intensivther Notfallmed 20: 251–260.

    Article  CAS  Google Scholar 

  29. Teasdale G, Jennett B (1976) Assessment of coma after head injury. Acta Neurochir (Wien) 34: 45–55.

    Article  CAS  Google Scholar 

  30. Tintinelli JE, Claffey J (1981) Complications of nasotracheal intubation. Ann Emerg Med 10:142–144.

    Article  Google Scholar 

  31. Rhee KJ, Green W, Holcroft JW et al. (1990) Oral intubation in the multiply injured patient: the risk of exacerbating spinal cord damage. Ann Emerg Med 19: 45–48.

    Google Scholar 

  32. Silverstone P (1989) Pulse oximetry at the roadside: a study of pulse oximetry in immediate care. BMJ 298: 711–713.

    Article  Google Scholar 

  33. Curley JF, Smyrnios NA (1991) Routine monitoring of the critically ill: In: Rippe JM, Irwin RS, Alpert JS, Fink MP (eds) Intensive care medicine. Little Brown, Boston, pp 199–214.

    Google Scholar 

  34. Bouma GJ, Muizelaar JP, Stringer A et al. (1992) Ultraearly evaluation of regional cerebral blood flow in severely head-injured patients using xenon-enhanced computerized tomography. J Neurosurg 77: 360–368.

    Article  PubMed  CAS  Google Scholar 

  35. Obrist WD, Marion DW, Aggarwal S (1993) Time course of cerebral blood flow and metabolic changes following severe head injury. Abstracts, 61st Annual Meeting of The American Neurological Surgeons, Boston, April.

    Google Scholar 

  36. Gopinath SP, Robertson CS, Contant CF et al. (1994) Jugular venous desaturationand out-come after head injury. Psychiatry Neurosci 57: 717–723.

    Article  CAS  Google Scholar 

  37. Muizelar JP, Marmarou A, Ward JD et al. (1991) Adverse effects of prolonged hyperventilation in patients with severe head injury: A randomized clinical trial. J Neurosurg 75: 731–739.

    Article  Google Scholar 

  38. Van Helden A, Schneider GH, Unterberg A et al. (1993) Monitoring of jugular venous oxygen saturation as a guide to therapy in severe head injury. Abstracts, 2nd International Neurotrauma Symposium, Glasgow, July.

    Google Scholar 

  39. Kiening KL, Unteiberg AW, Bardt TF et al. (1996) Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue PO2 versus jugular vein oxygen saturation. J Neurosurg 85: 751–757.

    Article  PubMed  CAS  Google Scholar 

  40. College of Surgeons (1989) Advanced trauma life support course. College of Surgeons, Chicago.

    Google Scholar 

  41. Valesco IT, Potieri Y, Rocha e Silva M et al. (1980) Hypertonic NaCl and severe hemorrhagic shock. Am J Physiol 239: 664–673.

    Google Scholar 

  42. Nakayama S, Sibley L, Gunther RA et al. (1984) Small volume resuscitation with hypertonic saline (2400 mOsmol/1) during hemorrhagic shock. Circ Shock 13:149–159.

    PubMed  CAS  Google Scholar 

  43. Rocha e Silva M, Negraes GA et al. (1986) Hypertonic resuscitation from severe hemorrhagic shock: patterns of regional circulation. Circ Shock 19:165–175.

    PubMed  CAS  Google Scholar 

  44. Meniga PA, Mattox KL, Pepe PE et al. (1989) Hypertonic saline-dextrane solutions for the prehospital management of traumatic hypotension. Am J Surg 157: 528–534.

    Article  Google Scholar 

  45. Vassar MJ, Perry CA, Gannaway WL et al. (1991) 7,5% sodium chloride/dextran for resuscitation of trauma patients undergoing helicopter transport. Arch Surg 126:1065–1072.

    Article  PubMed  CAS  Google Scholar 

  46. Freshman SP, Battisteila FD, Matteucci M et al. (1993) Hypertonic saline (7.5%) versus mannitol: a comparison for treatment of acute head injuries. J Trauma 35: 344–348.

    Article  PubMed  CAS  Google Scholar 

  47. Berger S, Schürer L, Hartl R et al. (1994) 7.2% NaCl/10% dextran 60 versus 20% mannitol for treatment of intracranial hypertension. Acta Neurochir Suppl (Wien) 60: 494–498.

    CAS  Google Scholar 

  48. Berger S, Schürer L, Hartl R et al. (1995) Reduction of post-traumatic intracranial hypertension by hypertonic/hyperoncotic saline/dextran and hypertonic mannitol. Neurosurgery 37: 98–107.

    Article  PubMed  CAS  Google Scholar 

  49. Taylor G, Myers S, Kurth CD et al. (1996) Hypertonic saline improves brain resuscitation in a pediatric model of head injury and hemorrhagic shock. J Pediatr Surg 31: 65–70.

    Article  PubMed  CAS  Google Scholar 

  50. Sheikh AA, Matsuoka T, Wisner DH (1996) Cerebral effects of resuscitation with hypertonic saline and a new low-sodium hypertonic fluid in hemorrhagic shock and head injury. Crit Care Med 24:1226–1232.

    Article  PubMed  CAS  Google Scholar 

  51. DeWitt DS, Prough DS, Deal DD et al. (1996) Hypertonic saline does not improve cerebral oxygen delivery after head injury and mild hemorrhage in cats. Crit Care Med 24:109–117.

    Article  PubMed  CAS  Google Scholar 

  52. Gunnar WD, Merlotti GJ, Jonasson O et al. (1986) Resuscitation from hemorrhagic shock: alterations of the intracranial pressure after normal saline, 3% saline and dextran 40. Ann Surg 204: 686–692.

    Article  PubMed  CAS  Google Scholar 

  53. Worthley LIG, Cooper DJ, Jones N (1988) Treatment of resistant intracranial hypertension with hypertonic saline. J Neurosurg 68: 478–481.

    Article  PubMed  CAS  Google Scholar 

  54. Holcroft JW, Vassar MJ, Turner JE et al. (1987) Three percent NaCl and 7.5% NaCl-dextran in the resuscitation of severely head-injured patients. Ann Surg 206: 279–288.

    Article  PubMed  CAS  Google Scholar 

  55. Tommasino C, Moore S, Todd MM (1988) Cerebral effects of isovolemic hemodilution with cristalloid or colloid solutions. Crit Care Med 16: 862–868.

    Article  PubMed  CAS  Google Scholar 

  56. Grumme Th, Baethmann A, Kolodziejczyk D et al. (1995) Treatment of patients with severe head injury by triamcinolone: a prospective, controlled multicenter clinical trial of 396 cases. Res Exp Med 195: 217–229.

    Article  CAS  Google Scholar 

  57. Wise BL, Chater ML (1962) The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebro-spinal pressure. J Neurosurg 19:1038–1043.

    Article  PubMed  CAS  Google Scholar 

  58. Shenkin HA, Goluboff B, Haft H (1962) The use of mannitol for the reduction of intracranial pressure in intracranial surgery. J Neurosurg 19: 897–901.

    Article  PubMed  CAS  Google Scholar 

  59. McQueen JD, Jeanes LD (1964) Dehydration and rehydration of the brain with hypertonic urea and mannitol. J Neurosurg 21:1–8.

    Google Scholar 

  60. Miller JD, Leech P (1975) Effects of mannitol and steroid therapy on intracranial volume-pressure relationships in patients. J Neurosurg 42: 274–281.

    Article  PubMed  CAS  Google Scholar 

  61. Cottrell JE, Robustelli A, Post K et al. (1977) Furosemide- and mannitol-induced changes in intracranial pressure and serum osmolarity and electrolytes. Anesthesiology 47:28–30.

    Article  PubMed  CAS  Google Scholar 

  62. Muizelaar JP, Lutz HA, Becker III DP (1984) Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head-injured patients.J Neurosurg 61 pp 700–706

    Article  PubMed  CAS  Google Scholar 

  63. Rosner MJ, Coley I (1987) Cerebral perfusion pressure: a hemodynamic mechanism of mannitol and the postmannitol hemogram. Neurosurgery 21:147–156.

    Article  PubMed  CAS  Google Scholar 

  64. Feldman Z, Kanter M, Robertson CS et al. (1992) Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients. J Neurosurg 76: 207–211.

    Article  PubMed  CAS  Google Scholar 

  65. Rosner MJ, Coley IB (1986) Cerebral perfusion pressure, intracranial pressure, and head elevation. J Neurosurg 65: 636–641.

    Article  PubMed  CAS  Google Scholar 

  66. Jennett B, Teasdale G, Galbraith S et al. (1977) Severe head injury in three countries. J Neurol Neurosurg Psychiatr 40: 291–298.

    Article  PubMed  CAS  Google Scholar 

  67. Miller JD, Butterworth JF, Gudeman SK et al. (1981) Further experience in the management of severe head injury. J Neurosurg 54: 289–299.

    Article  PubMed  CAS  Google Scholar 

  68. Gentleman D, Teasdale G, Murray L (1986) Cause of severe head injury and risk of complications. BMJ 292: 449–453.

    Article  PubMed  CAS  Google Scholar 

  69. Moskopp D, Böker KD, Kurthen M et al. (1990) Begleitende Wirbelsäulentraumata bei\Schädel-Hirn-Verletzten. Unfallchirurg 93:120–126.

    PubMed  CAS  Google Scholar 

  70. Pagni CA, Massaro F (1991) Concomitant cranio-cerebral and vertebro-medullary injuries. Analysis of 121 cases. Acta Neurochir 111:1–10.

    Article  CAS  Google Scholar 

  71. Hills MW, Deane SA (1993) Head Injury and facial injury: is there an increased risk of cervical spine injury? J Trauma 34: 549–554.

    Article  PubMed  CAS  Google Scholar 

  72. Busto R, Globus MY, Dietrich WD et al. (1989) Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain. Stroke 20: 904–910.

    Article  PubMed  CAS  Google Scholar 

  73. Marion DW, Obrist WD, Carlier PM (1993) The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report. J Neurosurg 79: 354–362.

    Article  PubMed  CAS  Google Scholar 

  74. Shiozaki T, Sugimoto H, Taneda M (1993) Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury. J Neurosurg 79: 363–368.

    Article  PubMed  CAS  Google Scholar 

  75. Clifton GL, Allen S, Barrodale P et al. (1993) A phase II study of moderate hypothermia in severe brain injury. J Neurotrauma 10: 263–271.

    Article  PubMed  CAS  Google Scholar 

  76. Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI) (1995) Stellungnahmen, Empfehlungen zu Problemen der Intensiv- und Notfallmedizin, 3rd edn, Asmuth, Cologne.

    Google Scholar 

  77. Bullock R, Chesnut RM, Clifton G et al. (1996) Guidelines for the management of severe head injury. J Neurotrauma 13: 639–734.

    Article  Google Scholar 

  78. Working Group “Neurosurgical Intensive Care/Neurotraumatology” of The German Socitey for Neurosurgery, Working Group “Neuroanaesthesia” of the German Society for Anesthesiology and Intensive Care Medicine (1996) Guidelines for the prehospital care of patients with head injuries. Mitteilungen der Deutschen Gesellschaft für Neurochirurgie 4.

    Google Scholar 

Download references

Authors
  1. J. Piek
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Zentrum für Operative Medizin I, Philipps-Universität Marburg, Baldingerstraße, D-35043, Marburg, Germany

    Bernhard L. Bauer  & Thomas J. Kuhn  & 

  2. Klinik für Neurochirurgie, Philipps-Universität, Baldingerstraße, 35033, Marburg, Germany

    Thomas J. Kuhn

Rights and permissions

Reprints and permissions

Copyright information

© 1997 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Piek, J. (1997). Preclinical Treatment of Patients With Severe Brain Injuries. In: Bauer, B.L., Kuhn, T.J. (eds) Severe Head Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-60761-5_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-60761-5_5

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-64544-0

  • Online ISBN: 978-3-642-60761-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation