STEP-BY-STEP THERAPY OF INTRACRANIAL HYPERTENSION IN THE ACUTE PERIOD OF SEVERE MECHANICAL TRAUMA IN CHILDREN



Cite item

Full Text

Abstract

Aim of the study to improve the results of treatment of children with intracranial hypertension in the acute period of severe mechanical trauma by virtue of the use of the “Protocol of step-by-step therapy” Material and methods. The article is devoted to the problem of intracranial hypertension in children with severe mechanical trauma. An analysis of 148 case histories of children with severe mechanical trauma, including brain trauma hospitalized in an intensive care unit. 27 patients out of 148 were excluded from the inclusion criteria: 6 patients (22.2%) due to the “late” admission (more than 72 hours from the time of injury); 21 patients - (77,8%) due to the persistent condition of atonic coma from the moment of trauma. 121 patients, according to indications, monitored intracranial pressure and intensive therapy of intracranial hypertension. All patients were divided into two groups: one group (the main one - 84 patients), in which the treatment was carried out according to the “Protocol of step-by-step therapy of intracranial hypertension” and approved in the Scientific Research Institute of Emergency Children’s Surgery and Traumatology, characterized by a strict sequence of treatment measures (“steps”), with clear indications for prescribing each subsequent “step” and the time frame for the duration of the “steps” taken; 2 group (control group - 37 patients), in which the treatment was carried out according to existing international guidelines for the management of patients with severe head injury. Conclusion. Comparative evaluation of treatment results showed outcomes of trauma in the main group to be better, including a statistically significantly less mortality rate (p = 0.0002, p < 0.05).

About the authors

I. A. Kolykhalkina

Research Institute of Emergency Pediatric Surgery and Traumatology

Author for correspondence.
Email: irina_kolyhalkina@mail.ru
Россия

V. G. Amcheslavsky

Research Institute of Emergency Pediatric Surgery and Traumatology

Email: noemail@neicon.ru
Россия

T. F. Ivanova

Research Institute of Emergency Pediatric Surgery and Traumatology

Email: noemail@neicon.ru
Россия

V. I. Lukyanov

Research Institute of Emergency Pediatric Surgery and Traumatology

Email: noemail@neicon.ru
Россия

L. M. Roshal

Research Institute of Emergency Pediatric Surgery and Traumatology

Email: noemail@neicon.ru
Россия

References

  1. The role of secondary brain injury in determining outcome from severe head injury. R.M. Chesnut, L.F. Marshall, M.R. Klauber et al. Journal of Trauma and Acute Care Surgery. 1993; 34: 216-22
  2. Амчеславский В.Г. Интенсивная терапия вторичных повреждений головного мозга в остром периоде черепно-мозговой травмы (диагностика, мониторинг, лечение ): автореф. дис. … д-ра мед.наук. В.Г. Амчеславский. М., 2002.
  3. Крылов В.В,. Талыпов А.Э,. Пурас Ю.В,. Ефременко С.В. Вторичные факторы повреждений головного мозга при черепно-мозговой травме. Российский медицинский журнал. 2009; 3: 23-8.
  4. Secondary brain injury in trauma patients: The effects of remote ischemic conditioning. B. Joseph,V. Pandit, B. Zangbar et al. Journal of Trauma and Acute Care Surgery. 2015; 78(40): 698-705.
  5. Secondary insults in subarachnoid hemorrhage: occurrence and impact on out come and clinical deterioration. M. Ryttlefors, T. Howells, P. Nilsson еt al. Neurosurgery. 2007. Vol. 61, N 4. P. 704-715.
  6. Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury. M. Balestreri, M. Czosnyka, P. Hutcginsonеt.al. Neurocritical Care. 2006; 4(1): 8-13.
  7. Marshall L.F. The outcome with aggressive treatment in severe head injuries. PartII: Acute and chronic barbiturate administration in the management of head injury. L.F. Marshall, R.W. Smith, H.M. Shapiro. Journal of Neurosurgery. 1979; 50(1): 26-30.
  8. Dynamic Three-Dimensional Scoring of Cerebral Perfusion Pressure and Intracranial Pressure Provides a Brain Trauma Index That Predicts Outcome in Patients With Severe Traumatic Brain Injury.S.Kahraman, P. Hu, D. Stein et al. Journal of Trauma-Injury Infection & Critical Care. 2011;70( 3): 547-53.
  9. Predicting secondary insults after severe traumatic brain injury. W. Bonds Brandon, Yang Shiming, Peter F. Hu et al. Journal of Trauma and Acute Care Surgery. 2015; 79(1): 85-90.
  10. Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents - second edition: erratum. P.M. Kochanek, N. Carney, P.D. Adelson et al. Pediatric Critical Care Medicine. 2012;13( 2):252.
  11. Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents - second edition. P.M. Kochanek, N. Carney, P.D. Adelson et al. Pediatric Critical Care Medicine. 2012; 13( 1): S1-82.
  12. Guidelines for the Management of Severe Traumatic Brain Injury: 3rd edition. M.R. Bullock, R.M. Chestnut, N.A. Carney et al. Journal of Neurotrauma. 2007; 24( 1): i-S-106 p.
  13. Клинические руководство по черепно-мозговой травме. В 3 т. Т. 1. Под ред. Коновалова А.Н., Лихтермана Л.Б., Потапова А.А. М.: Антидор 1998.
  14. Лечение пострадавших с тяжелой черепно-мозговой травмой: клин. рекомендации. Потапов А.А., Крылов В.В., Лихтерман Л.Б., Талыпов А.Э., Гаврилов А.Г., Петриков С.С. М.: 2014.
  15. Амчеславский В.Г., Потапов А.А. Интенсивная терапия при тяжелой черепно-мозговой травме с позиций доказательной медицины. Доказательная нейротравматология. Под ред. А. Потапова, Л.Б. Лихтермана. М.: НИИ нейрохирургии им. Н.Н. Бурденко РАМН, 2003. Глава 5. 142.
  16. Интенсивная терапия критический состояний у детей. Александрович Ю.С., Пшениснов К.В., Гордеев В.И. Санкт-Петербург: Изд-во Н-Л, 2014. Глава 9. Интенсивная терапия при церебральной недостаточности. С. 329.
  17. Kukreti V. Management of raised intracranial pressure in children with traumatic brain injury.V. Kukreti, H. Mohseni-Bod, J. Drake. Journal of Pediatric Neurosciences. 2014; 9(3): 207-15.
  18. Rosner M. J. Cerebral perfusion pressure, intracranial pressure and head elevation. M.J. Rosner, I.B. Coley. Journal of Neurosurgery. 1986; 65(5): 636-41.
  19. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. N.A. Carney, R. Chesnut, P.M. Kochanek. Pediatric Critical Care Medicine. 2003; 4(3): 68-71.
  20. Профилактика и лечение внутричерепной гипертензии у детей с тяжелой черепно-мозговой травмой (метод.рекомендации №25). Правительство Москвы; Департамент здравоохранения г. Москвы. Москва, 2014. 27 с.
  21. Семенова Ж.Б., Мельников А.В., Саввина И.А., Лекманов А.У., Хачатрян В.А., Горелышев С.К. Рекомендации по лечению детей с черепно-мозговой травмой. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2016; (2): 112-31.
  22. Крылов В.В. Внутричерпная гипертензия. Крылов В.В., Петриков С.С., Солодов А.А. Москва: БИНОМ, 2016. 216 с.
  23. Протокол оказания медицинской помощи пострадавшим с тяжелой черепно-мозговой травмой на госпитальном этапе [электронный ресурс]. Интенсивная терапия. Электрон.журн. 2008. № 2. Режим доступа: http://icj.ru/journal/number-2-2008/165-protokol-okazaniya-medicinskoy-pomoschi-postradavshim-s-tyazheloy-cherepno-mozgovoy-travmoy-na-gospitalnom-etape.html, свободный. Загл. с экрана.
  24. Intracranial pressure and cerebral perfusion pressure as risk factors in children withtraumatic brain injuries. A. Catala-Temprano, G. Claret-Teruel, F.J. Cambra-Lasaosa et al. Journal of Neurosurgery: Pediatrics. 2007; 106(6): 463-6.
  25. Significance of intracranial pressure and cerebral perfusion pressure in severe pediatric traumatic brain injury. D.E. Grinkevičiūtė, R. Kėvalas, A. Matukevičius et al. Medicina (Kaunas). 2008; 44( 2): 119-25.

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2018

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies