tailieunhanh - Báo cáo y học: "Recently published papers: of head injuries, high frequencies and haemodynamic optimization"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về y học đề tài: Recently published papers: of head injuries, high frequencies and haemodynamic optimization. | Critical Care December 2002 Vol 6 No 6 Kirk-Bayley and Venn Commentary Recently published papers of head injuries high frequencies and haemodynamic optimization Justin Kirk-Bayley1 and Richard Venn2 1Senior House Officer Worthing Hospital Lyndhurst Road Worthing West Sussex UK 2Consultant in Anaesthesia and Intensive Care Worthing Hospital Lyndhurst Road Worthing West Sussex UK Correspondence Justin Kirk-Bayley jkb@ Published online 6 November 2002 Critical Care 2002 6 468-470 DOI cc1850 This article is online at http content 6 6 468 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X That we have come a long way in recent years in the management of head injuries is apparent that we need to travel further down this road is more so. However are some of our current management strategies actually deleterious Coles and coworkers 1 raised the prospect of yet another double-edged sword. Examining hyperventilation for control of cerebral hypertension they used positron emission tomography to map regional cerebral blood flow. Defining the critical hypoperfusion threshold as a cerebral blood flow of 10 ml 100 g per min they reduced arterial partial carbon dioxide tension from to kPa in healthy volunteers and head-injured patients and found a significant increase in the volume of hypoperfused tissue despite improvements in intracranial pressure ICP and cerebral perfusion pressure. Despite the availability of evidence-based national guidelines for the management of the severely head-injured patient 2 Bulger and colleagues 3 showed that adherence to these guidelines at least in the USA is still very variable. Looking at 34 centres those investigators found considerable variations in care especially when they looked at numbers of patients being intubated before hospital admission or undergoing ICP monitoring. Only 35 of centres placed ICP monitors in more than 50 of patients who met the recommended criteria. The centres .