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The patients of trauma offers a special challenge because of the associated head injury, maxillofacial, neck and spine injuries, which puts the airway at imminent risk. The response time for the emergency team to initiate the airway management determines the outcome of the individual undergoing treatment. A judious implementatin of triage and Advanced Trauma Life Suport (ATLS) guidelines are helpful in the allocation of resources in airway management of trauma patients. One must not get distracted with the severity of other organ systems because cerebral tissue permits a low threshold to the hypoxic insults. Adequate preparedness and a team effort result in better airway management and improved outcomes in trauma patients with variable hemodynamic response to resuscitation. All possible efforts must be made to secure a definitive airway (if required) and should be verified clinically as well as with the available adjuncts. The success of a trauma team depends on the familiarity to the airways devices and their discrete application in various situations. [ABSTRACT FROM AUTHOR]

Raised intracranial pressure is common leading cause of mortality in patients suffering from a traumatic craniocerebral injury. Currently, head injury constitutes a major public health problem across the world. Decompressive craniectomy is currently emerging as a preferred treatment strategy for patients suffering from refractory intracranial hypertension, which is unresponsive to appropriate neurocritical care management. The meticulous execution of decompressive craniectomy requires an understanding of anatomy, the pathogenesis of raised intracranial pressure, meticulous surgical technique, proper planning in association with the competent anesthetic team and paramedical staff to provide improved neurological outcome, and a significant reduction in mortality and morbidity. We provide a review of the status and appropriate review of this surgical procedure. High Lights: After over 100 years of the decompressive craniectomy (DC) procedure, clear indications are not present. Great variability exists for this technique, yielding variation in outcomes and creating comparative data. Decompressive craniectomy has been shown to decrease intracranial pressure and mortality. Decompressive craniectomy might increase vegetative state rates. [ABSTRACT FROM AUTHOR]

Objective: To review the influence of metabolic dysfunction of glucose after traumatic brain injury on patient mortality. Materials and methods: We searched PubMed, Scopus, EBSCOhost, Medline, and Embase electronic databases, involving publications from 1980 to August 2017 in English and Spanish. Results: The glucose metabolism in brain involved in brain signal conduction, neurotransmission, synaptic plasticity, and cognitive function. Insulin levels traverse the blood–brain barrier by utilizing an insulin receptor protein as a carrier, playing a pivotal role in various cognitive functions while also regulating energy metabolism. TBI causes elevated blood glucose levels. Hyperglycemia is attributed to an acute sympatho-adrenomedullary response, resulting in elevated catecholamines, increased levels of cortisol, and IL-6. Moreover, there is a potential association with hypothalamic involvement. Additionally, hyperglycemia is linked to lactic acidosis at the tissue level, ultimately contributing to higher mortality rates. Conclusions: The monitoring and control of glucose should be an important part of multimodal monitoring in patients with moderate to severe traumatic brain injury managed in neurocritical care units. A management protocol should ensure normoglycemia and early detection and correction of glucose abnormalities since it improves patients' clinical outcomes. [ABSTRACT FROM AUTHOR]

Traumatic brain injury carries a high risk of neurological disability and fatality. The extent of the injury to the neuronal tissue following a head impact defines the primary injury. The acceleration energy delivered at the time of impact provokes this injury. There are numerous secondary responses to the injury that mostly intensify the primary injury. When a head impact causes a contusion, the hemorrhagic injury frequently progresses over the first few hours after impact, either growing or developing new, non-contiguous hemorrhagic lesions, a condition known as the hemorrhagic progression of a contusion. [ABSTRACT FROM AUTHOR]

The brain-lung interaction can seriously affect patients with traumatic brain injury, triggering a vicious cycle that worsens patient prognosis. Although the mechanisms of the interaction are not fully elucidated, several hypotheses, notably the "blast injury" theory or "double hit" model, have been proposed and constitute the basis of its development and progression. The brain and lungs strongly interact via complex pathways from the brain to the lungs but also from the lungs to the brain. The main pulmonary disorders that occur after brain injuries are neurogenic pulmonary edema, acute respiratory distress syndrome, and ventilator-associated pneumonia, and the principal brain disorders after lung injuries include brain hypoxia and intracranial hypertension. All of these conditions are key considerations for management therapies after traumatic brain injury and need exceptional case-by-case monitoring to avoid neurological or pulmonary complications. This review aims to describe the history, pathophysiology, risk factors, characteristics, and complications of brain-lung and lung-brain interactions and the impact of different old and recent modalities of treatment in the context of traumatic brain injury. [ABSTRACT FROM AUTHOR]

The article discusses the use of the wake-up test as a valuable tool in assessing the progression of patients with severe traumatic brain injury (TBI) in neurointensive care units. The test requires certain conditions to be met, such as stable intracranial pressure, cerebral perfusion pressure, and oxygenation levels. The article emphasizes the importance of reducing sedation in order to conduct a meaningful examination. The wake-up test is considered an essential part of neurointensive care for severe TBI patients, and further research is needed to explore its impact on outcomes. [Extracted from the article]

Patients with acute neurological diseases (traumatic brain injury, hemorrhagic or ischemic stroke, spinal cord injury or tumour) may present with various systemic alterations such as changes in cardiovascular and respiratory response, gastrointestinal function disorders, metabolic and endocrinological abnormalities, coagulopathies, among others. Head injury increases the risk of malnutrition due to multiple factors related to nutrient intake, abnormalities in energy expenditure, eating behaviour disorders, gastrointestinal changes, and medication side effects. Gastrointestinal conditions include gastroparesis, which is defined as a delay in gastric emptying in the absence of mechanical obstruction. These patients often report nausea, vomiting, pain, postprandial fullness and abdominal swelling. Although the exact mechanism by which it occurs in traumatic brain injury is not known, it is related to complications such as intracranial hypertension, so it is most often seen in cases of severe trauma. Therefore, the objective of this review is to expose basic and practical concepts about gastroparesis and its approach. [ABSTRACT FROM AUTHOR]

Systematically review the medical literature for the impact of beta-blockers on mortality and functional capacity in patients who suffered severe traumatic brain injury. The search included MEDLINE, EMBASE, and Ovid Evidence-Based Medicine, clinical trial registries, and bibliographies. All articles that reported outcome in TBI patients treated with beta-blockers. Publication year, number of patients, outcome and follow-up. We performed a meta-analysis for each variable for which there were sufficient data to estimate mean differences. 12 studies were included, which involved retrospectively and prospectively collected data on 14,057 patients. The treatment with beta-blockers was associated with a reduction in mortality in patients who were treated with beta-blockers compared to the control group (OR 0.40, 95% CI 0.30–0.54p = <0.00001), with acceptable heterogeneity between studies (I2 = 65% p = 0.00008). Beta-blocker therapy decreases the risk of negative neurological and functional outcomes (OR 0.59, 95% CI 0.38–0.92 p = <0.00001), a very high statistical heterogeneity between the included studies (I2 = 80% p = 0.00004), being able to influence the results. An increase in favorable neurological and functional outcomes is shown (OR 1.19, 95% CI 1.07–1.31 p = 0.001) with acceptable heterogeneity (I2 = 52% p = 0.08) The beta-blockers therapy is associated with significantly improves outcome in patients with TBI. Treatment with beta-blockers in patients with TBI is a promising frontier in neurotrauma. CI: confidence interval; BB: Beta-Blockers; OR = odds ratio; TBI: Traumatic Brain Injury SD: Standard deviation; SNS: Sympathetic nervous system [ABSTRACT FROM AUTHOR]

THIEME 98 Hope or Hype: Beta-Blockers in Traumatic Brain Injury Luis Rafael Moscote-Salazar 1,2 Tariq Janjua 3 William A Florez-Perdomo 4, Harold Vasquez 4,5 1 Paracelsus Medical University, Salzburg, Austria 2 Department of Neurosurgery, Center of Biomedical Research, University of Cartagena, Cartagena de Indias, Colombia 3 Neurocritical Care Unit, Regions Hospital, Saint Paul, Minnesota, United States 4 Latinamerican Council of Neurocritical Care, Colombia 5 Department of Medicine, Universidad del Sinu, Cartagena, Colombia published online September 29, 2020 Address for correspondence Luis Rafael Moscote-Salazar, MD, Department of Neurosurgery, University of Cartagena, Cra. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India Traumatic brain injury (TBI) has significant consequences for patients, families, and healthcare systems worldwide. [Extracted from the article]