Zusammenfassung
Das schwere Schädel-Hirn-Trauma (SHT) ist mit einem Anteil von annähernd 20% aller Schädel-Hirn-Verletzungen nicht selten. Insbesondere die Frühphase seiner Versorgung ist für den gesamten weiteren Ablauf und damit die Prognose ausschlaggebend. Nach der präklinischen und notfallmäßigen operativen Versorgung ist es zentrale Aufgabe der neurochirurgischen Intensivmedizin, den zerebralen Sekundärschaden möglichst gering zu halten. Da die komplexen, zu einer Aggravation des initialen Traumas führenden pathologischen Mechanismen noch nicht vollständig geklärt sind, unterliegen die entsprechenden Behandlungsansätze einem ständigen Wandel. Es wird ein Überblick über die aktuellen gängigen Therapieprinzipien gegeben: Diese werden jedoch mit zunehmendem Verständnis der komplexen Vorgänge beim SHT eine weitere Optimierung und damit Veränderung erfahren.
Abstract
Severe traumatic brain injury (TBI) is not a rare occurrence, accounting for almost 20% of all craniocerebral injuries. The early phase of care is particularly crucial for the entire further course and hence the prognosis. After preclinical and emergency surgical care, the key task of neurosurgical intensive care medicine is to ensure that cerebral secondary damage is kept to a minimum. Since the complex pathological mediators and mechanisms leading to aggravation of the initial trauma are not yet fully clarified, the relevant treatment approaches are subject to constant change. This article presents an overview of the current treatment principles commonly observed: these will however be optimized and adapted as understanding of the complex processes involved in TBI increases.
Literatur
Battison C, Andrews PJ, Graham C (2005) Randomized, controlled trial of the effect of 20% mannitol solution and a 7,5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med 33:196–202
Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, Ghajar J et al (2007) Guidelines for the management of severe traumatic brain injury. J Neurotrauma [Suppl 1] 24:S91–95
Clifton GL, Miller ER, Choi SC (2002) Fluid tresholds and outcome from severe brain injury. Crit Care Med 30:739–745
Cormio M, Valadka AB, Robertson CS (1999) Elevated jugular venous oxygen saturation after severe head injury. J Neurosurg 90:9–15
Diringer MN, Videen TO, Yundt K (2002) Regional cerebrovascular and metabolic effects of hyperventilation after severe traumatic brain injury. J Neurosurg 96:103–108
Grände PO, Bentzer (2010) Clinical aspect on evaluation of autoregulation after a severe traumatic brain injury. J Trauma 69(1):241
Henderson WR, Dhingra VK, Chittock DR (2003) Hypothermia in the management of traumatic brain injury: a systematic review and meta-analysis. Intensive Care Med 29:1637–1644
Kang TF (2002) Propofol infusion syndrome in critically il patients. Ann Pharmacother 36:1453–1456
Kleindienst A, Harvey HB, Mater E (2003) Early antithrombotic prophylaxis with low molecular weight heparin in neurosurgery. Acta Neurochir (Wien) 145:1085–1090
Lane PL, Skoretz TG, Doing G (2000) Intracranial pressure monitoring and outcomes after traumatic brain injury. Can J Surg 43:442–448 (ind ICP)
Lozier AP, Sciacca RR, Romanoli M (2002) Ventriculostomy-related infection: a critical review of the literature. Neurosurgery 51:170–182
Manley G, Knudson M, Morabito D (2001) Hypotension, hypoxia and head injury: frequency, duration and consequences. Arch Surg 136:1118–1123
Patanwala AE, Amini A, Erstad BL (2010) Use of hypertonic saline injection in trauma. Am J Health Syst Pharm 67(22):1920–1928
Peterson E, Chesnut RM (2009) Static autoregulation is intact in majority of patients with severe traumatic brain injury. J Trauma 67(5):944–949
Peterson K, Carson S, Carney N (2008) Hypothermia treatment for traumatic brain injury: a systematic review and meta analysis. J Neurotrauma 25(1):62–71
Piper I, Barnes A, Smith D (2001) The Camino intracranial pressure monitoring sensor: Is it optimal technology? An internal audit with a review of current intracranial pressure monitoring technologies. Neurosurgery 49:1158–1164
Rangel-Castilla L, Gasco J, Okonkwo DO, Robertson C (2008) Cerebral pressure autoregulation in traumatic brain injury. Neurosurg Focus 25(4):E7
Rangel-Castilla L, Lara LR, Gopinath S et al (2010) Cerebral hemodynamic efects of acute hyperoxia and hyperventilation after traumatic brain injury. J Neurotrauma 27(10):1853–1863
Rickels E, Wild K von, Wenzlaff P, Bock WJ (Hrsg) (2006) Schädel-Hirn-Verletzung. Epidemiologie und Versorgung, Ergebnisse einer prospektiven Studie. Zuckschwerdt, München
Roberts L (2000) Barbiturates for acute traumatic brain injury. Cochrane Database Syst Rev 2:CD000033
Roberts I, Yates D, Sandercock P (2004) Effect of intravenous corticosteroids on death within 14 days in 10 008 adults with clinically significant head injury (MRC CRASH trial): randomized placebo controlled trial. Lancet 364:1321–1328
Rosner MJ, Daughton S (1990) Cerebral perfusion pressure management in head injury. J Trauma 30:933–940
Temkin NR, Dikmen SS, Anderson GD (1999) Valproate therapy for prevention of posttraumatic seizures: a randomized trial. J Neurosurg 91:593–600
Timmons SD (2010) Current trends in neurotrauma care. Crit Care Med [Suppl 9] 38:431–444
Van den Brink WA, Van Santbrink H, Steyerberg EW (2000) Brain oxygen tension in severe head injury. Neurosurgery 46:868–878
Interessenkonflikt
Keine Angaben
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schaan, M., Strowitzki, M. Intensivtherapie des Schädel-Hirn-Traumas. Trauma Berufskrankh 13 (Suppl 1), 171–175 (2011). https://doi.org/10.1007/s10039-011-1736-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10039-011-1736-x
Schlüsselwörter
- Hirnverletzungen
- Schädel-Hirn-Trauma
- Zerebraler Sekundärschaden
- Neurochirurgische Intensivmedizin
- Therapieprinzipien