Document Detail

PRO: the "Lund concept" for treatment of patients with severe traumatic brain injury.
MedLine Citation:
PMID:  21593694     Owner:  NLM     Status:  MEDLINE    
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.
Per-Olof Grände
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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    
Department of Anesthesia and Intensive Care, Lund University, Sweden.
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MeSH Terms
Brain / physiopathology
Brain Edema / etiology,  physiopathology,  therapy
Brain Injuries / complications,  physiopathology,  therapy*
Decompressive Craniectomy
Hypothermia, Induced
Intracranial Hypertension / etiology,  physiopathology,  therapy
Practice Guidelines as Topic*
Respiratory Insufficiency / etiology,  physiopathology,  therapy
Treatment Outcome
Erratum In:
J Neurosurg Anesthesiol. 2011 Oct;23(4):375

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

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