PDF | It is unclear whether decompressive craniectomy improves the functional outcome in patients with severe traumatic brain injury and. The Decompressive Craniectomy in Diffuse Traumatic Brain Injury or DECRA trial was the first neurosurgical randomized controlled trail that sought to answer. BACKGROUND It is unclear whether decompressive craniectomy improves the functional outcome in patients with severe traumatic brain injury and refractory.
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Whether DC is too radical for mild TBI patients or has been already powerless for extremely severe TBI deserves further investigation by subgroup analysis. Kjellberg RN, Prieto A. Although barbiturates are included in level II recommendations of TBI guideline 5a Cochrane systematic review concluded that barbiturates may reduce ICP but do not reduce mortality or improve outcome in severe TBI survivors Search within my specialty: Initially, general measures such as normothermia and sedation are used followed by first-line therapeutic measures such as moderate hypocapnia and mannitol.
Most patients were of type V in 37 Second, timing of DC. Oxford Textbooks in Surgery. Child and Adolescent Psychiatry. The trial was conducted over a decade in centers across New Zealand, Saudi Arabia, and Australia, and the results were published in ; patients were randomized to two cohorts, the medical management cohort and the medical management plus DC cohort.
Cochrane Database Syst Rev. Historically, the removal of different parts of the skull has been utilized in the management of severe TBI after the first reports of this surgical technique directed at controlling ICH were published by Cushing. Decompressive craniectomy in diffuse traumatic brain injury. Would decompressive craniectomy really bring the hope to severe traumatic brain injury?
Decompressive Craniectomy in Diffuse Traumatic Brain Injury: The DECRA Trial – Oxford Medicine
However, patients undergoing craniectomy had worse scores on the Extended Glasgow Outcome Scale than those receiving standard care odds ratio for a worse score in the craniectomy group, 1. In addition, evidences also suggest that low cerebral perfusion pressure CPP at levels below 50—55 mmHg is one of the major contributors to unfavourable clinical outcome, so modern intensive-care management of severe TBI can also base on CPP-driven therapeutic protocol 14 Patients with higher Marshall CT grading had poorer prognosis.
Australian Bureau of Statistics. The results showed that, in contrast to medical care, decompressive craniectomy DC in patients with TBI and refractory intracranial hypertension can not only immediately and constantly reduce intracranial pressure ICP but, even more importantly, result in a nearly 20 percent reduction in mortality at 6 and 12 months.
Exploring the beneficiary patient population and operation timing remain the prime concerns.
Table 3 Number of patients with Glasgow coma scale at the time of admission. In addition, the main similarity between the results of these two studies was that DC reduced ICP effectively but increase larger proportion of survivors in the vegetative state and severe disability significantly. Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma.
Nursing Studies Obstetrics and Gynaecology Gynaecology. However, some studies suggested that high ICP was not the most powerful predictor of neurological worsening, and models used to predict outcome adopted age, motor response in GCS, pupil reactivity and some characteristics of the initial computed tomography CT scan as input variables Oxford Respiratory Medicine Library.
Decompressive Craniectomy in Diffuse Traumatic Brain Injury: An Industrial Hospital Study
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A comparison of craniotomy with decompressive craniectomy. Patients were divided into two groups based on Glasgow coma scale GCS score at presentation. These includes use of barbiturates, hyperventilation, moderate hypothermia, or removal of a variable amount of skull bone decompressive craniectomy [DC]. Allied Health Professions Arts Therapies. Decompressive craniectomy for traumatic intracranial hypertension: Second Group B are the craniectlmy without any surgically amenable mass lesions but with medically intractable raised ICP.
Cite this article as: Conflicts of interest There are no conflicts of interest. However, there were some inherent differences between these two studies.
In spite of achieving superior ICP control and intensive care outcomes, the DC cohort had worse long-term outcomes. Intracranial pressure thresholds in severe traumatic brain injury: Undoubtedly, it is one of the carniectomy encouraging clinical researches in the field of TBI in the past five years.
OSHs in Pain Medicine. Showing of 33 references.
The final primary outcome was the score on the Extended Glasgow Outcome Scale at 6 months. PatelPeter W.