This week we look at TBI and discuss some of the pitfalls and pearls in early management of traumatic ICH.
This week we look at TBI and discuss some of the pitfalls and pearls in early management of traumatic ICH.
Take Home Points
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Hopper AH. Hyperosmolar therapy for raised intracranial pressure. NEJM 2012; 367(8): 746-52. PMID: 22913684
Wang X et al. Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials. J Anesth 2014; 28(6): 821-7. PMID: 24859931
Zeiler FA et al. The ketamine effect on ICP in traumatic brain injury. Neurocrit Care 2014; 21(1): 163-73. PMID: 24515638
Hello Dr. Swaminathan,
Just a comment regarding your reference to ATACH 2 and INTERACT 2. Both of these trials look at spontaneous ICH, not traumatic ICH which is being discussed here. Given the underlying etiology of spontaneous ICH is almost always uncontrolled chronic hypertension, it makes sense that rapid lowering of BP in someone who has chronic hypertension would not improve outcomes. I don’t think its necessarily appropriate to extrapolate this data for the traumatic ICH population.
That’s a great point and I shouldn’t have generalized those studies to the traumatic patient. Most traumatic ICH improves with pain control but, occasionally, hypertension persists. I’m still not sure what our goal should be in these patients. Thanks for the comments!