ICU SAQs · Raised ICP & TBI
The secondary injury and the failed neuroprotective agents
A CICM SAQ on secondary injury prevention via the tiered algorithm and the evidence retiring steroids, hypothermia and progesterone.
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Prompt
A patient with severe traumatic brain injury is admitted to your ICU. Define the secondary brain injury and outline the measures that prevent it. Then critically appraise the evidence for corticosteroids, prophylactic hypothermia and progesterone as neuroprotective agents in traumatic brain injury.
Question
A patient with severe traumatic brain injury is admitted to your ICU. Define the secondary brain injury and outline the measures that prevent it. Then critically appraise the evidence for corticosteroids, prophylactic hypothermia and progesterone as neuroprotective agents in traumatic brain injury.[1][2][3]
References5ShowHide
- [1]Roberts I, Yates D, Sandercock P, et al. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial. Lancet (London, England), 2004.PMID 15474134
- [2]Andrews PJ, Sinclair HL, Rodriguez A, et al. Hypothermia for Intracranial Hypertension after Traumatic Brain Injury. The New England journal of medicine, 2015.PMID 26444221
- [3]Skolnick BE, Maas AI, Narayan RK, et al. A clinical trial of progesterone for severe traumatic brain injury. The New England journal of medicine, 2014.PMID 25493978
- [4]Wright DW, Yeatts SD, Silbergleit R, et al. Very early administration of progesterone for acute traumatic brain injury. The New England journal of medicine, 2014.PMID 25493974
- [5]Hawryluk GWJ, Aguilera S, Buki A, et al. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive care medicine, 2019.PMID 31659383