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TBI

Tchaka Shepherd tshepherdmd at hotmail.com
Thu Oct 27 15:56:14 BST 2005


Effect of Intracranial pressure monitoring and targeted intensive care on 
functional outcome after severe head injury.   Critical Care Medicine 33(10) 
2207-2213  October 2005


>From: "Ian Seppelt" <SeppelI at wahs.nsw.gov.au>
>To: <tshepherdmd at hotmail.com>
>Subject: Re: TBI
>Date: Thu, 27 Oct 2005 16:52:42 +1000
>
>What is the reference, please
>
>Ian Seppelt FANZCA FJFICM
>Staff Specialist in Intensive Care Medicine
>The Nepean Hospital,
>PO Box 63, Penrith NSW 2751
>Clinical Lecturer, University of Sydney
>
>
> >>> tshepherdmd at hotmail.com 10/27/05 03:19pm >>>
>Recent article out of the netherlands-- Objective was to determine the
>effect of ICP/CPP targeted intensive care on functional outcome and therapy
>intensity levels after severe head injury. To make this brief their
>conclusion which is pretty compelling ---" we were unable to demonstrate a
>trend toward a more favorable functional outcome with the use of an ICP/CPP
>targeted critical care protocol" Obviously not a randomized-controlled
>prospective trials but still extremely fascinating. During my fellowship
>training we aggressively treated ICP/CPP although there is truly no good
>data to support this.  I was hoping for a few comments. What are the
>opinions regarding the best way to managed Severe TBI?  Why not perform a
>randomized controlled trial?  Is it truly unethical if we could provide 
>some
>insight in to the appropriate management of neurotrauma?
>
>                T. Shepherd
> >From: "Ian Seppelt" <SeppelI at wahs.nsw.gov.au>
> >Reply-To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
> >To: <tangentcarrot at hotmail.com>, <trauma-list at trauma.org>
> >Subject: Re: Colloid infusion in the trauma patient
> >Date: Thu, 27 Oct 2005 11:56:11 +1000
> >
> >Big world of caution:
> >
> >You will recall that in SAFE (New Engl J Med 2004, 350:2247-2256) the a
> >priori trauma subgroup (17.3% of 7000 patients, making it the biggest 
>ever
> >trauma fluid study) showed evidence of harm when albumin was given to
> >trauma patients. On subgroup analysis this harm appeared to be restricted
> >to those with a traumatic brain injury. A 2 year followup of these TBI
> >patients has been analysed and is about to be published and you should 
>all
> >look very closely at the results (I can't say more until it hits the
> >press).
> >
> >The other big message from SAFE is that the 3:1 colloid to crystalloid
> >ratio that we are taught in books (which comes from healthy volunteer 
>dogs
> >in the 1950s) is utter rubbish when applied to sick humans. In every
> >subgroup there was a consistent 1.4:1 ratio (volume of albumin conpared 
>to
> >volume of saline, to acheive a clinical resuscitation endpoint). This 
>will
> >creep into the books eventually.
> >
> >For now I think it is fair to say that anyone who gives colloids to a
> >trauma patient in ICU is being very unwise!
> >
> >Cheers, Ian
> >
> >Ian Seppelt FANZCA FJFICM
> >Staff Specialist in Intensive Care Medicine
> >The Nepean Hospital,
> >PO Box 63, Penrith NSW 2751
> >Clinical Lecturer, University of Sydney
> >
> >
> > >>> tangentcarrot at hotmail.com 10/23/05 01:24am >>>
> >Actually, niyher do us.
> >But it is available for use with patients who's transfer to the hospital 
>is
> >greatly delayed (not saying that it will be used in such a case, only 
>that
> >it's available. It's for doctor to decide, as much as I can recall it's 
>not
> >indicated by some protocol or something)
> >
> >Do you use it with trauma patients in the ICU?
> >
> >
> >
> > >From: flysurg at aol.com
> > >Reply-To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
> > >To: trauma-list at trauma.org
> > >Subject: Re: Colloid infusion in the trauma patient
> > >Date: Sat, 22 Oct 2005 11:07:43 -0400
> > >
> > >We NEVER use colloids in initial resuscitation, prehospital or 
>otherwise.
> > >The literature clearly does not support colloid use.
> > >
> > >Steve Smith
> > >
> > >-----Original Message-----
> > >From: oded private <tangentcarrot at hotmail.com>
> > >To: trauma-list at trauma.org
> > >Sent: Fri, 21 Oct 2005 18:25:32 +0200
> > >Subject: Colloid infusion in the trauma patient
> > >
> > >
> > >Hello trauma list
> > >
> > >Lately, I have been dealing with the teaching of fluid ressuscitation 
>in
> > >trauma to EMT-B'S (not directly by teaching but by dealing with 
>contents
> >of
> > >the class and consulting with instructors) and the subject of the use 
>of
> > >colloid solutions (under the doctor's order only. of course) came up, 
>so
> > >I'd like t o here from those of you who have had expreince with this
> > >therapy (both in the pre-hospital and trauma-room settings) to share 
>your
> > >knowledge and experience with me- what solutions did use? does any of 
>you
> > >continue to practice this therapy? did you find it to have significant
> > >adventages over using soley cristalloids? How did you avoid or manage 
>its
> > >complications and dangers?
> > >
> > >Looking forward to your respondes and wishing you a happy succot,
> > >Oded
> > >
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