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Head trauma: risk factors for early brain death – our experience

Introduction

In a group of patients that evolved in brain death after head trauma, we evaluated the risk factors for an early brain death (in the first 3 days) among the parameters collected prehospital, in the emergency room (ER) and during the ICU stay.

Method

All the consecutive patients admitted to the ER of Careggi Hospital that evolved to brain death after head trauma during the period January 2004–June 2006 were considered (n = 54). The following parameters were considered for the study: prehospital phase: hypoxemia (SaO2 < 95%), hypotension (SAPS II < 90 mmHg), orotracheal intubation, fluids (>1,000 or ≤1,000 ml), and GCS; ER phase (ATLS approach): hypoxemia, hypotension, orotracheal intubation, fluids, GCS, blood lactate, pharyngeal temperature, and ISS; ICU stay: SAPS II, daily SOFA score, blood lactate, core temperature, glycaemia, and ScVO2 (>75% or ≤75%). On the basis of the timing of brain death, the patients were divided into two groups: group 1 (n = 27), brain death occurred in the first 3 days; group 2 (n = 27), brain death occurred in the days after. Statistics were determined with the Student t and chi-squared tests; P < 0.05 was considered significant.

Results

The significant differences between the two groups are reported in Table 1. A strict relationship exists between early brain death and prehospital treatment. During the ICU stay low levels of ScVO2 and high levels of glycaemia are related to early brain death.

Table 1

Conclusion

The results of the study confirm that prehospital hypotension is the main risk factor for an early evolution to brain death in head trauma. Also, patients that have prolonged hypoperfusion and neurohormonal imbalance after the postresuscitation phase present an increased risk of brain death.

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Di Filippo, A., Damiani, S., Migliaccio, M. et al. Head trauma: risk factors for early brain death – our experience. Crit Care 11, P353 (2007). https://doi.org/10.1186/cc5513

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Keywords

  • Emergency Room
  • Early Evolution
  • Core Temperature
  • Blood Lactate
  • Head Trauma