Giedrė Zinkevičiūtė Žarskienė, Diana Bilskienė, Andrius Macas
Traumatic brain injury is the leading cause of death and further cause of disability and a major public health problem. Although the severity of the injury depends directly on the primary brain injury, secondary brain injury deteriorates the outcomes. The main causes of secondary ischemic injury include hypotension (systolic blood pressure <90mmHg) and hypoxaemia (PaO2<60mmHg), which are directly associated with increase of morbidity and mortality due to severe traumatic brain injury. Hypoxia and hypotension during decompresive craniotomy are independently associated with significant increaeses in vegetative state development and higher frequency of disability. Intraoperative period, including immediate anaesthesia during urgent craniotomy, is a critical moment for these patients. Their intraoperative hypotension can be caused by various factors, such as blood loss due other traumatic injuries, direct pulmonary or heart disorders, sympathetic tone lesions (spinal cord injury and neurogenic shock), potent anesthetic medicaments action or current hypovolemia and inadequate infusion therapy. How to solve this situation? Usually we choose a larger infusion therapy and vasoactive drugs. Is it realy a best solution for the patient? Severe brain trauma and related complications are the most common morbidity and mortality causes in young and middle-aged people. The initial injury we can not influence, but to avoid the major secondary brain injury risks, especially such as hypotension and hypoxia, are required. Only quick and accurate diagnosis, secondary risk factors prevention and immediate treatment may improve the outcomes.
Keyword(s): traumatic brain injury; Cushing response; low blood pressure; hypovolemia; hemodynamic paremeters; secondary brain damage
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