Document Detail


Barbiturate therapy for patients with refractory intracranial hypertension following severe traumatic brain injury: its effects on tissue oxygenation, brain temperature and autoregulation.
MedLine Citation:
PMID:  17997313     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The aim of this study was to explore the effects of barbiturate coma on cerebral tissue oxygen tension and cerebrovascular pressure reactivity (PRx), as an index of cerebral autoregulation in severe head injury patients. This was a prospective observational clinical study of 12 patients with severe traumatic brain injury, carried out at a tertiary-level neurosurgical intensive care unit between April 2002 and May 2005. All patients received standard neurosurgical intensive care and monitoring. Probes for intracranial pressure (ICP), brain temperature (BT) and brain tissue oxygenation (PTiO2) were inserted into (noncontused) normal-looking white matter. Cerebrovascular PRx was measured as a moving correlation between ICP and arterial blood pressure. Barbiturate coma was instituted when ICP became refractory (ICP>20 mmHg). All data from the multimodal monitoring were digitally extracted and statistically analysed. The mean ICP decreased with barbiturate coma in eight of the 12 patients (75% of the patients), but only four achieved a value below 20 mmHg. Of eight patients with prebarbiturate PTiO2 levels above 10 mmHg, six had a further improvement in oxygenation. Thus, concordant favourable changes in ICP, PRx and PTiO2 with barbiturate coma were seen in those who survived. Effective response to barbiturates can be detected by improved PTiO2 and autoregulation (PRx) in severe head injury patients.
Authors:
J D Thorat; E C Wang; K K Lee; W T Seow; I Ng
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article     Date:  2007-11-07
Journal Detail:
Title:  Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia     Volume:  15     ISSN:  0967-5868     ISO Abbreviation:  J Clin Neurosci     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2007-12-28     Completed Date:  2008-06-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9433352     Medline TA:  J Clin Neurosci     Country:  Scotland    
Other Details:
Languages:  eng     Pagination:  143-8     Citation Subset:  IM    
Affiliation:
Acute Brain Injury Research Laboratory, Department of Neurosurgery, Tan Tock Seng Hospital, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. jthorat@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Barbiturates / therapeutic use*
Body Temperature / drug effects*
Brain / drug effects*,  physiopathology
Brain Injuries / complications
Female
Glasgow Coma Scale
Homeostasis / drug effects*
Humans
Intracranial Hypertension / drug therapy*,  etiology,  pathology*
Intracranial Pressure / drug effects
Male
Middle Aged
Oxygen Consumption
Prospective Studies
Retrospective Studies
Statistics, Nonparametric
Chemical
Reg. No./Substance:
0/Barbiturates; 67-52-7/barbituric acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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