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Chapter 14 - Therapeutic Options in Neurocritical Care

Beyond the Brain

Published online by Cambridge University Press:  28 April 2020

Peter C. Whitfield
Affiliation:
Derriford Hospital, Plymouth
Jessie Welbourne
Affiliation:
University Hospitals, Plymouth
Elfyn Thomas
Affiliation:
Derriford Hospital, Plymouth
Fiona Summers
Affiliation:
Aberdeen Royal Infirmary
Maggie Whyte
Affiliation:
Aberdeen Royal Infirmary
Peter J. Hutchinson
Affiliation:
Addenbrooke’s Hospital, Cambridge
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Summary

It has long been recognised that a neurological injury can elicit profound systemic complications, from Harvey Cushing who in 1903 described strategies to limit fatal haemodynamic dysfunction during surgical CNS surgery to reports of pulmonary oedema post-seizures in 1908.1

Studies of patients admitted to intensive care with traumatic brain injury (TBI) showed that up to 89% developed non-neurological organ dysfunction, worsening their outcome.2,3 Most commonly patients develop sepsis, respiratory or cardiovascular complications with rates of 75%, 41% and 44% respectively in one cohort.3 Renal and hepatic system involvement is much less common.4 The presence of hypotension, severe respiratory failure or sepsis has been shown to be independent predictors of death and mortality rates rise from 31%–40% for single organ failure to 47%–91% with two organ system failures and up to 100% in cases with three or more organ system failures.

Type
Chapter
Information
Traumatic Brain Injury
A Multidisciplinary Approach
, pp. 164 - 185
Publisher: Cambridge University Press
Print publication year: 2020

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