Intensive Care Medicine

, Volume 32, Issue 10, pp 1475–1484 | Cite as

The “Lund Concept” for the treatment of severe head trauma – physiological principles and clinical application

Review

Abstract

The Lund Concept is an approach to the treatment of severe brain trauma that is mainly based on hypotheses originating from basic physiological principles regarding brain volume and cerebral perfusion regulation. Its main attributes have found support in experimental and clinical studies. This review explains the principles of the Lund Concept and is intended to serve as the current guide for its clinical application. The therapy has two main goals: (1) to reduce or prevent an increase in ICP (ICP-targeted goal) and (2) to improve perfusion and oxygenation around contusions (perfusion-targeted goal). The Lund therapy considers the consequences of a disrupted blood–brain barrier for development of brain oedema and the specific consequences of a rigid dura/cranium for general cerebral haemodynamics. It calls attention to the importance of improving perfusion and oxygenation of the injured areas of the brain. This is achieved by normal blood oxygenation, by maintaining normovolaemia with normal haematocrit and plasma protein concentrations, and by antagonizing vasoconstriction through reduction of catecholamine concentration in plasma and sympathetic discharge (minimizing stress and by refraining from vasoconstrictors and active cooling). The therapeutic measures mean normalization of all essential haemodynamic parameters (blood pressure, plasma oncotic pressure, plasma and erythrocyte volumes, PaO2, PaCO2) the use of enteral nutrition, and avoidance of overnutrition. To date, clinical outcome studies using the Lund Concept have shown favourable results.

Keywords

Brain trauma Brain edema Brain volume regulation Cerebral perfusion Guideline Intracranial pressure Penumbra 

Notes

Acknowledgements

The author received support from the Swedish Research Council (grant no.11581), from the Faculty of Medicine, Lund University, Lund, Sweden, and from Region Skåne, Sweden.

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of Anaesthesiology and Intensive CareUniversity Hospital of LundLundSweden

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