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Neuroprotection in acute brain injury: an up-to-date review

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Abstract

Neuroprotective strategies that limit secondary tissue loss and/or improve functional outcomes have been identified in multiple animal models of ischemic, hemorrhagic, traumatic and nontraumatic cerebral lesions. However, use of these potential interventions in human randomized controlled studies has generally given disappointing results. In this paper, we summarize the current status in terms of neuroprotective strategies, both in the immediate and later stages of acute brain injury in adults. We also review potential new strategies and highlight areas for future research.

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Abbreviations

CBF:

Cerebral blood flow

CPP:

Cerebral perfusion pressure

Hb:

Hemoglobin

ICH:

Intracerebral hemorrhage

ICP:

Intracranial pressure

IMPACT:

International Mission on Prognosis and Analysis of randomized Controlled Trials

MSC:

Mesenchymal stromal cell

PbtO2 :

Brain tissue oxygen tension

SAH:

Subarachnoid hemorrhage

TBI:

Traumatic brain injury

TH:

Therapeutic hypothermia

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Authors and Affiliations

  1. Department of Physiopathology and Transplant, Milan University, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F Sforza 35, 20122, Milan, Italy

    Nino Stocchetti

  2. Neuro ICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F Sforza 35, 20122, Milan, Italy

    Nino Stocchetti

  3. Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, 1070, Brussels, Belgium

    Fabio S Taccone & Jean-Louis Vincent

  4. Department of Health Science, University of Milan-Bicocca, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy

    Giuseppe Citerio

  5. NeuroIntensive Care, Department of Emergency and Intensive Care, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy

    Giuseppe Citerio

  6. Department of Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 75390-8579, USA

    Paul E Pepe

  7. Department of Neurosurgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA

    Peter D Le Roux

  8. Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) University Hospital, Faculty of Biology and Medicine, University of Lausanne, 1011, Lausanne, Switzerland

    Mauro Oddo

  9. Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA

    Kees H Polderman

  10. Division of Neuroscience Critical Care, Division of Adult Critical Care, Johns Hopkins Medicine, Baltimore, MD, 21287, USA

    Robert D Stevens

  11. NETT Clinical Coordinating Center, University of Michigan, Ann Arbor, MI, 48106-0381, USA

    William Barsan & Robert Silbergleit

  12. Department of Neurosurgery, University Hospital Antwerp and University of Antwerp, 2650, Edegem, Belgium

    Andrew IR Maas

  13. Department of Intensive Care, UZ Leuven, Campus Gasthuisberg, 3000, Leuven, Belgium

    Geert Meyfroidt

  14. Department of Critical Care Medicine and the Safar Center for Resuscitation Research, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA

    Michael J Bell

  15. Department of Neurocritical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA

    Paul M Vespa

  16. Center for Shock, Trauma & Anesthesiology Research (STAR), University of Maryland School of Medicine, Baltimore, MD, 21201, USA

    Alan I Faden

  17. Department of Neurology, Neurocritical Care Unit, Innsbruck Medical University, 6020, Innsbruck, Austria

    Raimund Helbok

  18. Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA

    Samuel Tisherman

  19. IRCCS – Istituto di Ricerche Farmacologiche Mario Negri, Department of Neuroscience, 20156, Milan, Italy

    Elisa R Zanier

  20. Department of Emergency Medicine, University of Arizona, Tucson, AZ, 85724-5057, USA

    Terence Valenzuela

  21. Institute of Liver Studies, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK

    Julia Wendon

  22. Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK

    David K Menon

Authors
  1. Nino Stocchetti
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  2. Fabio S Taccone
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  3. Giuseppe Citerio
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  4. Paul E Pepe
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  5. Peter D Le Roux
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  6. Mauro Oddo
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  7. Kees H Polderman
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  8. Robert D Stevens
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  9. William Barsan
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  10. Andrew IR Maas
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  11. Geert Meyfroidt
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  12. Michael J Bell
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  13. Robert Silbergleit
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  14. Paul M Vespa
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  15. Alan I Faden
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  16. Raimund Helbok
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  17. Samuel Tisherman
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  18. Elisa R Zanier
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  19. Terence Valenzuela
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  20. Julia Wendon
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  21. David K Menon
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  22. Jean-Louis Vincent
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Corresponding author

Correspondence to Nino Stocchetti.

Additional information

Competing interests

PDLR receives research funding from Integra Lifesciences, Neurologica, the Dana Foundation and the National Institutes of Health; is a consultant for Integra Lifesciences, Codman, Synthes, and Neurologica; and is a member of the scientific advisory board of Cerebrotech, Brainsgate, Orsan, and Edge Therapeutics. MO is supported by grants from the Swiss National Science Foundation (grant number 320030_138191) and the Novartis Foundation for Biomedical Research. MJB reports receipt of National Institutes of Health grant U01 NS081041. ST is co-author on the patent 'Emergency Preservation and Resuscitation Method'. The remaining authors declare that they have no competing interests.

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Stocchetti, N., Taccone, F.S., Citerio, G. et al. Neuroprotection in acute brain injury: an up-to-date review. Crit Care 19, 186 (2015). https://doi.org/10.1186/s13054-015-0887-8

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