Biomedical subjects

T Gautille

Publications and source records attributed to T Gautille.

5 recordsLinked to original sources

PubMed1998

Neurogenic hypotension in patients with severe head injuries.

OBJECTIVE: To examine the occurrence of hypotensive episodes in patients with severe traumatic brain injuries that are not of hypovolemic origin and to investigate possible neurogenic or iatrogenic causes of such episodes. METHODS: We reviewed Traumatic Coma Data Bank (TCDB) records of the 248 patients with early hypotension. We attempted to eliminate episodes related to hemorrhagic hypovolemia by excluding patients with (1) extracranial injuries of Abbreviated Injury Scale scores > 3 (n = 99, 40%); (2) postresuscitation hematocrit levels < 35% (n = 76, 30.6%); (3) hematocrit levels decreasing to < 35% during the first 24 hours after injury (n = 47, 19%); and (4) patients with conflicting data (n = 5, 2%). This left 21 patients (8.5%) without discernible extracranial causes for their hypotension. RESULTS: Of these 21 patients, 4 had no extracranial injuries and 4 had only a single injury with Abbreviated Injury Scale score = 1. Hypotensive episodes were not associated with terminal or unsalvageable status. Mortality was 43%. Of the multiple factors investigated, the only two that were strongly associated with these "unexplained" hypotensive episodes were the presence of a diffuse injury pattern on computed tomography (n = 15, 71%) and the early use of mannitol or furosemide (n = 16, 76%) (It was policy at TCDB centers that hypotensive patients not receive diuretics until they were resuscitated.) CONCLUSIONS: (1) Some episodes of severe traumatic brain injury-related hypotension may be of neurogenic origin. (2) The risk/benefit ratio of early diuretic use in patients with severe traumatic brain injuries may be too high to support liberal use. These data strongly support the need for a study involving prospective collection of data describing the early blood pressure courses in such patients.

Adolescent↗

PubMed1994

The localizing value of asymmetry in pupillary size in severe head injury: relation to lesion type and location.

Reliable Assessment of the probability that a head injury patient harbors a surgical intracranial lesion is critical to both triage and treatment. The authors analyzed data from 608 patients with severe head injuries (Glasgow Coma Scale score, < or = 8) in the Traumatic Coma Data Bank to assess the reliability of pupillary asymmetry in predicting the presence and location of an intracranial mass lesion. Of 210 patients with pupillary asymmetry of > or = 1 mm, 63 (30%) had intracranial mass lesions, 52 (25%) of which were extra-axial in location, 38 (73%) of these located ipsilateral to the larger pupil. Of 51 patients with asymmetry of > or = 3 mm, 22 (43%) had intracranial mass lesions, 18 (35%) of which were extra-axial in location, 14 (64%) of these located ipsilateral to the larger pupil. For both asymmetry categories, strong interactions were found with age and mechanism of injury, the highest incidence of extra-axial lesions occurring in older patients injured other than as occupants of motor vehicles. The authors developed regression equations that provide a graphic means to predict the presence of an intracranial hematoma using data on pupillary asymmetry, age, and mechanism of injury. This predictive model, interpreted in a hospital- and patient-specific fashion, should be of significant use in directing triage, activating diagnostic and therapeutic resources, and evaluating the utility of exploratory trephination.

Accidents, Traffic↗

PubMed1990

Large and small "holes" in the brain: reversible or irreversible changes in head injury.

We prospectively studied the frequency and course of large (greater than 25 cc) and small (less than 25 cc) areas of decreased density in 491 patients with severe closed head injury entered into the Traumatic Coma Data Bank (TCDB). The frequency of such areas and of subarachnoid haemorrhage on initial and subsequent CT scans were recorded. The frequency of large "holes" increased from 8 on the initial CT scan to 24 on scans done from day 4 to day 10. Half of these lesions either completely or almost completely resolved 14 days or more following injury. In patients with small "holes" the frequency increased from 24 to 77, but on scans performed 14 days or more following injury, 47% had completely disappeared. The presence of subarachnoid haemorrhage on the initial scan predicted the development of large areas of decreased density, but it did not predict the development of small areas of decreased density. The disappearance of a substantial number of these areas of decreased density ("holes") indicate that these areas do not necessarily represent areas of cerebral infarction. Patients with closed head injury are at risk for the development of what appear to be regional areas of cerebral ischaemia, but subarachnoid haemorrhage only predicts the development of large areas with these changes. Pharmacologic trials with calcium channel blocking agents or NMDA receptor antagonists in head injured patients appear warranted.

Brain↗

PubMed1988

The Traumatic Coma Data Bank: a nursing perspective, Part I.

The Traumatic Coma Data Bank (TCDB) was a collaborative project undertaken to study the nature and causes of severe head injury, allowing patients similar in age, severity of insults and neurological and physical symptoms to be compared in terms of outcome. Systematic uniform data were collected during the prehospital, acute and rehabilitative phases on 581 patients from 6 centers during the pilot phase of the TCDB, June 1, 1979 through May 31, 1982. The pilot phase successfully determined that a collaborative approach to studying head injury was feasible and additional information gained was incorporated into the main phase April, 1983 through April, 1988. A description of the TCDB population as of this writing (730 patients) is included here.

Adolescent↗

PubMed1988

The Traumatic Coma Data Bank: a nursing perspective, Part II.

The Traumatic Coma Data Bank (TCDB) was a collaborative project undertaken to study the nature and course of severe head injury. Evolution of nursing goals includes collection of data, communication, new clinical observations, designing future research projects, education and legislative impact. Management issues inherent in the collaborative research project are defining, collecting, entering, and analyzing and publishing results.

Brain Injuries↗