Document Detail


PRO: the "Lund concept" for treatment of patients with severe traumatic brain injury.
MedLine Citation:
PMID:  21593694     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Two different main concepts for the treatment of severe traumatic brain injury have been established during the last 15 years, namely the more conventional concept recommended in well-established guidelines (eg, the US Guideline, European Guideline, Addelbrook's Guideline from Cambridge) on the one hand, and the Lund concept from the University Hospital of Lund, Sweden on the other. Owing to the lack of well-controlled randomized outcome studies comparing these 2 main therapeutic approaches, we cannot conclude that one is better than the other. This study is the PRO part in a PRO-CON debate on the Lund concept in the present journal. Although the Lund concept is based on a physiology-oriented approach dealing with hemodynamic principles of brain volume and brain perfusion regulation, traditional treatments are primarily based on a meta-analytic approach from clinical studies. High cerebral perfusion pressure has been an essential goal in the conventional treatments (the cerebral perfusion pressure-guided approach), even though it has been modified in a recent update of US guidelines. The Lund concept has instead concentrated on management of brain edema and intracranial pressure, simultaneously with improvement of cerebral perfusion and oxygenation (the intracranial pressure and perfusion-guided approach). Although conventional guidelines are restricted to clinical data from meta-analytic surveys, the physiological approach of the Lund therapy finds support in both experimental and clinical studies. It offers a wider base and can also give recommendations regarding fluid therapy, lung protection, optimal hemoglobin concentration, temperature control, the use of decompressive craniotomy, and ventricular drainage. This study puts forward arguments in support of the Lund therapy.
Authors:
Per-Olof Grände
Related Documents :
21798514 - Application of zen sitting principles to microscopic surgery seating.
24042154 - Lactate or scvo2 as an endpoint in resuscitation of shock states?
9173934 - Otolithic and tonic neck receptors control of limb blood flow in humans.
1858664 - The physiological cost of wearing a disposable respirator.
16217064 - Transverse sinus stenoses persist after normalization of the csf pressure in iih.
10022424 - Estrogen supplementation attenuates glucocorticoid and catecholamine responses to menta...
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Journal of neurosurgical anesthesiology     Volume:  23     ISSN:  1537-1921     ISO Abbreviation:  J Neurosurg Anesthesiol     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-09     Completed Date:  2011-10-13     Revised Date:  2011-10-19    
Medline Journal Info:
Nlm Unique ID:  8910749     Medline TA:  J Neurosurg Anesthesiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  251-5     Citation Subset:  IM    
Affiliation:
Department of Anesthesia and Intensive Care, Lund University, Sweden. per-olof.grande@med.lu.se
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Brain / physiopathology
Brain Edema / etiology,  physiopathology,  therapy
Brain Injuries / complications,  physiopathology,  therapy*
Decompressive Craniectomy
Humans
Hypothermia, Induced
Intracranial Hypertension / etiology,  physiopathology,  therapy
Practice Guidelines as Topic*
Respiratory Insufficiency / etiology,  physiopathology,  therapy
Sweden
Treatment Outcome
Comments/Corrections
Erratum In:
J Neurosurg Anesthesiol. 2011 Oct;23(4):375

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


Previous Document:  Intensive Insulin Therapy Increases the Risk of Hypoglycemia in Neurocritical Care Patients.
Next Document:  Effect of Autologous Blood Transfusion on Cerebral Cytokine Expression.