Efficacy of a Novel Prophylactic Barbiturate Therapy for Severe Traumatic Brain Injuries: Step-down Infusion of a Barbiturate with Normothermia
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- KAJIWARA Sosho
- Department of Neurosurgery, Kurume University School of Medicine
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- HASEGAWA Yu
- Department of Neurosurgery, Kurume University School of Medicine Department of Pharmaceutical Sciences, International University of Health and Welfare
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- NEGOTO Tetsuya
- Department of Neurosurgery, Kurume University School of Medicine
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- ORITO Kimihiko
- Department of Neurosurgery, Kurume University School of Medicine
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- KAWANO Takayuki
- Department of Neurosurgery, Kurume University School of Medicine
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- YOSHITOMI Munetake
- Department of Neurosurgery, Kurume University School of Medicine
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- SAKATA Kiyohiko
- Department of Neurosurgery, Kurume University School of Medicine
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- TAKESHIGE Nobuyuki
- Department of Neurosurgery, Kurume University School of Medicine
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- YAMAKAWA Yukako
- Department of Pharmacy, Kumamoto University Hospital
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- JONO Hirofumi
- Department of Pharmacy, Kumamoto University Hospital
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- SAITO Hideyuki
- Department of Pharmacy, Kumamoto University Hospital
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- HIRAYU Nobuhisa
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine
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- TAKASU Osamu
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine
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- HIROHATA Masaru
- Department of Neurosurgery, Kurume University School of Medicine
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- MORIOKA Motohiro
- Department of Neurosurgery, Kurume University School of Medicine
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Abstract
<p>This study aimed to examine the beneficial effects of a novel prophylactic barbiturate therapy, step-down infusion of barbiturates, using thiamylal with normothermia (NOR+sdB), on the poor outcome in the patients with severe traumatic brain injuries (sTBI), in comparison with mild hypothermia (MD-HYPO). From January 2000 to March 2019, 4133 patients with TBI were admitted to our hospital. The inclusion criteria were: a Glasgow coma scale (GCS) score of ≤8 on admission, age between 20 and 80 years, intracranial hematoma requiring surgical evacuation of the hematoma with craniotomy and/or external decompression, and patients who underwent management of body temperature and assessed their outcome at 6–12 months. Finally, 43 patients were included in the MD-HYPO (n = 29) and NOR+sdB (n = 14) groups. sdB was initiated intraoperatively or immediately after the surgical treatment. There were no significant differences in patient characteristics, including age, sex, past medical history, GCS on admission, type of intracranial hematoma, and length of hospitalization between the two groups. Although NOR+sdB could not improve the patient’s poor outcome either at discharge from the intensive care unit (ICU) or at 6–12 months after admission, the treatment inhibited composite death at discharge from the ICU. The mean value of the maximum intracranial pressure (ICP) in the NOR+sdB group was <20 mmHg throughout the first 120 h. NOR+sdB prevented composite death in the ICU in patients with sTBI, and we may obtain novel insights into the beneficial role of prophylactic barbiturate therapy from suppression of the elevated ICP during the first 120 h.</p>
Journal
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- Neurologia medico-chirurgica
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Neurologia medico-chirurgica 61 (9), 528-535, 2021
The Japan Neurosurgical Society