Therapeutic options in neurocritical care: Beyond the brain

Cardio-respiratory issues in head-injured patients. Systemic complications of head injury. Systemic complications of head injury are common. A review of 209 patients admitted to intensive care with traumatic brain injury (TBI) showed that 89% developed nonneurological dysfunction in at least one other organ system, worsening the outcome. This is a high incidence in a group of patients who are typically younger – the median age in this trial was 36 – and with less co-morbidity than other intensive care patients. The reasons for the increased incidence of complications after TBI may be due to the systemic effects of the brain injury itself, the presence of other associated injuries and the complications of treatment. The implications of systemic complications following head injury are increasingly recognized and attracting more attention. The presence of one organ failure is reportedly associated with a mortality rate of 40%increasing to 47% with two organ failures and to 100% with three ormore organs failing. The commonest organ failures were cardiovascular and respiratory. Cardiovascular complications. Cardiac dysfunction is well documented following subarachnoid haemorrhage and can result in global dysfunction, regional wall abnormalities and subendocardial changes, presumably secondary to the accompanying catecholamine surge. Cardiac dysfunction occurs less frequently following traumatic brain injury, despite it also being associated with a well-documented catecholamine surge. Studies of patients who died following TBI show that 16%–41% of patients had echocardiographic evidence of myocardial dysfunction thought to be due to release of catecholamines. Post-mortem studies show a characteristic pattern of myocardial damage with contraction band necrosis and myocytolysis, a pattern that is distinct to that seen in myocardial ischaemia.