‘ROSE concept’ of fluid management: Relevance in neuroanaesthesia and neurocritical care

AbstractFluid therapy in neurosurgical patients aims to restore intravascular volume, optimise haemodynamic parameters and maintain tissue perfusion, integrity and function. The goal is to minimise the risk of inadequate cerebral perfusion pressure and to maintain good neurosurgical conditions. However, fluid management in brain-injured patients has several distinctive features compared with non-brain-injured critically ill patients. The ROSE concept advocates the restriction of fluids, which is consistent with the prevention of a ‘tight brain’ in neurosurgery. Whether this imbalance in fluid management studies between different types of brain injuries is a reflection of differences in clinical relevance of fluid management is not clear. Further randomised controlled trials in the future are essential in subarachnoid haemorrhage and traumatic brain injury patients who are critical and need long-term Intensive Care Unit stay to elucidate and define the role and relevance of the ROSE concept in neuroanaesthesia and neurocritical care.

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The Expanding Role of Quantitative Pupillometry in the Evaluation and Management of Traumatic Brain Injury

Frontiers in Neurology ◽

10.3389/fneur.2021.685313 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jason H. Boulter ◽

Margaret M. Shields ◽

Melissa R. Meister ◽

Gregory Murtha ◽

Brian P. Curry ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Brain Injuries ◽

Ease Of Use ◽

Brain Injured ◽

The World ◽

Injured Patients ◽

Austere Environments ◽

Active Investigation

Traumatic brain injury is a rapidly increasing source of morbidity and mortality across the world. As such, the evaluation and management of traumatic brain injuries ranging from mild to severe are under active investigation. Over the last two decades, quantitative pupillometry has been increasingly found to be useful in both the immediate evaluation and ongoing management of traumatic brain injured patients. Given these findings and the portability and ease of use of modern pupillometers, further adoption and deployment of quantitative pupillometers into the preclinical and hospital settings of both resource rich and medically austere environments.

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SPLATT Combined with Tendo Achilles Lengthening for Spastic Equinovarus in Adults: Results and Predictors of Surgical Outcome

Foot & Ankle ◽

10.1177/107110079301400605 ◽

1993 ◽

Vol 14 (6) ◽

pp. 335-338 ◽

Cited By ~ 21

Author(s):

Peter Edwards ◽

John Hsu

Keyword(s):

Surgical Outcomes ◽

Postoperative Management ◽

Ambulatory Status ◽

Brain Injured ◽

Anterior Tibial ◽

Ambulatory Patients ◽

And Function ◽

Injured Patients ◽

Spastic Quadriparesis

During a 4-year period, split anterior tibial tendon transfer (SPLATT) was performed on 42 adults with cerebrospastic equinovarus deformity. Twenty-one patients (24 feet) had a minimum 1-year follow-up, which included detailed documentation of foot appearance position and function as well as ambulatory status. Thirteen patients were male and 8 were female. Average age of the patients was 41 years. Seventeen patients were independent ambulators with orthoses, one was a maximally assisted ambulator. Three patients with spastic quadriparesis were nonambulatory. All patients had uniform surgical technique and postoperative management. This paper presents the results of SPLATT and identifies risk factors for poor surgical outcomes. After an average follow-up of 39 months, 83% of the feet were rated as having good or excellent results. All ambulatory patients had improved gait and 35% of them were able to discontinue their orthoses. Poor surgical outcomes were associated with nonambulatory status in brain injured patients ( P = .018). Salvage of failed SPLATT is discussed.

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Management of lower extremity strength and function in traumatically brain-injured patients

Journal of Head Trauma Rehabilitation ◽

10.1097/00001199-199012000-00006 ◽

1990 ◽

Vol 5 (4) ◽

pp. 43-50 ◽

Cited By ~ 2

Author(s):

Diana D. Cardenas ◽

David R. Clawson

Keyword(s):

Lower Extremity ◽

Lower Extremity Strength ◽

Brain Injured ◽

Traumatically Brain Injured ◽

And Function ◽

Injured Patients

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COBI (COntinuous hyperosmolar therapy for traumatic Brain-Injured patients) trial protocol: a multicentre randomised open-label trial with blinded adjudication of primary outcome

BMJ Open ◽

10.1136/bmjopen-2017-018035 ◽

2017 ◽

Vol 7 (9) ◽

pp. e018035 ◽

Cited By ~ 9

Author(s):

Antoine Roquilly ◽

Sigismond Lasocki ◽

Jean Denis Moyer ◽

Olivier Huet ◽

Pierre François Perrigault ◽

...

Keyword(s):

Standard Care ◽

Primary Outcome ◽

Trial Protocol ◽

Open Label ◽

Hyperosmolar Therapy ◽

Brain Injured ◽

Registration Number ◽

Randomised Controlled ◽

Injured Patients

IntroductionTraumatic brain injury (TBI) is a major cause of death and severe prolonged disability. Intracranial hypertension (ICH) is a critical risk factor of bad outcomes after TBI. Continuous infusion of hyperosmolar therapy has been proposed for the prevention and the treatment of ICH. Whether an early administration of continuous hyperosmolar therapy improves long-term outcomes of patients with TBI is uncertain. The aim of the COBI study (number clinicaltrial.gov 03143751, pre-results stage) is to assess the efficiency and the safety of continuous hyperosmolar therapy in patients with TBI.Methods and analysisThe COBI (COntinuous hyperosmolar therapy in traumatic Brain-Injured patients) trial is a multicentre, randomised, controlled, open-label, two-arms study with blinded adjudication of primary outcome. Three hundred and seventy patients hospitalised in intensive care unit with a TBI (Glasgow Coma Scale ≤12 and abnormal brain CT scan) are randomised in the first 24 hours following trauma to standard care or continuous hyperosmolar therapy (20% NaCl) plus standard care. Continuous hyperosmolar therapy is maintained for at least 48 hours in the treatment group and continued for as long as is necessary to prevent ICH. The primary outcome is the score on the Extended Glasgow Outcome Scale at 6 months. The treatment effect is estimated with ordinal logistic regression adjusted for prespecified prognostic factors and expressed as a common OR.Ethics and disseminationThe COBI trial protocol has been approved by the ethics committee of Paris Ile de France VIII and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. The COBI trial is the first randomised controlled trial powered to investigate whether continuous hyperosmolar therapy in patients with TBI improve long-term recovery.Trial registration numberTrial registration number isNCT03143751.

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Structure-Function Relationships in Brain-Injured Patients: A Scoping Review

10.31222/osf.io/wnhye ◽

2020 ◽

Author(s):

Nicholas Parsons ◽

Matthew Hughes ◽

Govinda Poudel ◽

Juan F. Dominguez D. ◽

Karen Caeyenberghs

Keyword(s):

Structure Function ◽

Scoping Review ◽

Brain Injuries ◽

Structural Connectivity ◽

Normal Structure ◽

Theoretical Frameworks ◽

Brain Injured ◽

Structure Function Relationship ◽

Function Relationship ◽

Injured Patients

The human brain is a dynamic network comprised of elements which are structurally connected and functionally interactive. A tight structure-function relationship is vital for this system to produce seamless cognition and behaviour. Brain injuries due to either neurological disease or single-event injuries alter the dynamics of normal structure-function interaction, resulting in poor neurobehavioural outcomes for patients. This scoping review is a synthesis of recent progress in understanding how brain injuries alter the structure-function relationship. We identified 16 studies that investigated the structure-function relationship in brain-injured cohorts, using fMRI and either T1-weighted or diffusion-weighted MRI to calculate, respectively, grey matter density or structural connectivity. Overall, a reduced structure-function relationship was found in brain-injured patients relative to healthy controls. This weakened relationship coincided with impaired cognition. Structural and functional MRI information should also be reconciled into suitable graph theoretical frameworks such as the multilayer network approach

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Management of Severely Brain-Injured Patients Recovering from Coma in the Neurocritical Care Unit

Neurocritical Care ◽

10.1017/9781107587908.034 ◽

2019 ◽

pp. 404-413

Author(s):

Caroline Schnakers ◽

Martin M. Monti

Keyword(s):

Neurocritical Care ◽

Brain Injured ◽

Injured Patients

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Specific Computerized Attention Training in Stroke and Traumatic Brain-Injured Patients

Zeitschrift für Neuropsychologie ◽

10.1024/1016-264x.14.4.283 ◽

2003 ◽

Vol 14 (4) ◽

pp. 283-292 ◽

Cited By ~ 18

Author(s):

W. Sturm ◽

B. Fimm ◽

A. Cantagallo ◽

N. Cremel ◽

P. North ◽

...

Keyword(s):

Divided Attention ◽

Single Case ◽

Baseline Period ◽

Specific Training ◽

Attention Task ◽

Baseline Phase ◽

Computerized Training ◽

Brain Injured ◽

Divided Attention Task ◽

Injured Patients

Abstract: In a multicenter European approach, the efficacy of the AIXTENT computerized training programs for intensity aspects (alertness and vigilance) and selectivity aspects (selective and divided attention) of attention was studied in 33 patients with brain damage of vascular and traumatic etiology. Each patient received training in one of two most impaired of the four attention domains. Control tests were performed by means of a standardized computerized attention test battery (TAP) comprising tests for the four attention functions. Assessment was carried out at the beginning and at the end of a four week baseline period and after the training period of 14 one-hour sessions. At the end of the baseline phase, there was only slight but significant improvement for the most complex attention function, divided attention (number of omissions). After the training, there were significant specific training effects for both intensity aspects (alertness and vigilance) and also for the number of omissions in the divided attention task. The application of inferential single case procedures revealed a high number of significant improvements in individual cases after specific training of alertness and vigilance problems. On the other hand, a non specific training addressing selectivity aspects of attention lead either to improvement or deterioration of alertness and vigilance performance. The results corroborate the findings of former studies with the same training instrument but in patients with different lesion etiologies.

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