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01-12-2006 | Correspondence

Comment on “The Lund Concept for the treatment of severe head trauma—physiological principles and clinical application”

Authors: Juan A. Llompart-Pou, Jon Pérez-Bárcena, Josep M. Abadal, Javier Homar

Published in: Intensive Care Medicine | Issue 12/2006

Excerpt

Sir: We read with interest the article by Grände [1] summarizing the guidelines of the “Lund Concept” to treat intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI). This concept is based on “physiological” principles with two main goals:

To reduce ICP
To improve microcirculation and reduce edema in pericontusional areas

We would like to call attention to their use of high-dose boluses of methylprednisolone (5–10 mg/kg iv) to treat elevated temperature in TBI patients, as adverse side effects of steroids must be considered: …

Grände PO (2006) The “Lund Concept” for the treatment of severe head trauma—physiological principles and clinical application. Intensive Care Med 32:1475–1484PubMedCrossRef

Cohan P, Wang C, McArthur DL, Cook SW, Dusick JR, Armin B, Swerdloff R, Vespa P, Muizelaar JP, Cryer HG, Christenson PD, Kelly DF (2005) Acute secondary adrenal insufficiency after traumatic brain injury: a prospective study. Crit Care Med 33:2358–2366PubMedCrossRef

Dimopoulou I, Tsagarakis S, Kouyalis AT, Roussou P, Assithianakis G, Christoforaki M, Illias I, Sakas DE, Thalassinos N, Roussos C (2004) Hypothalamic-pituitary-adrenal axis dysfunction in critically ill patients with traumatic brain injury: Incidence, pathophysiology, and relationship to vasopressor dependence and peripheral interleukin-6 levels. Crit Care Med 32:404–408PubMedCrossRef

Marik P, Zaloga GP (2002) Adrenal insufficiency in the critically ill. A new look to and old problem. CHEST 122:1784–1796PubMedCrossRef

Barton RN, Stoner HB, Watson SM (1987) Relationships among plasma cortisol, adrenocorticotropin and severity of injury in recently injured patients. J Trauma 27:384–392CrossRef

Llompart-Pou JA, Raurich JM, Ibáñez J, Burguera B, Barceló A, Ayestarán JI, Pérez-Bárcena J (in press) Relationship between plasma ACTH and ICU survival in early traumatic brain injury. J Trauma

Matsumura M, Kakishita H, Suzuki M, Banba N, Hattori Y (2001) Dexamethasone suppresses iNOS gene expression by inhibiting NF-κ β in vascular smooth muscle cells. Life Sci 69:1067–1077PubMedCrossRef

Edwards P, Arango M, Balica L, Cottingham R, El-Sayed H, Farrell B, Fernandes J, Gogichaisvili T, Golden N, Hartzenberg B, Husain M, Ulloa MI, Jerbi Z, Khamis H, Komolafe E, Laloe V, Lomas G, Ludwig S, Maizairac G, Muñoz Sánchez Mde L, Nasi L, Olldashi F, Plunkett P, Roberts I, Sandercock P, Shakur H, Soler C, Stocker R, Svoboda P, Trenkler S, Venkataramana NK, Wasserberg J, Yates D, Yutthakasemsunt S; CRASH trial collaborators (2005) Final results of MRC CRASH, a randomised placebo-controlled trial on intravenous corticosteroid in adults with head injury—outcomes at 6 months. Lancet 365:1957–1959PubMedCrossRef

Title: Comment on “The Lund Concept for the treatment of severe head trauma—physiological principles and clinical application”
Authors: Juan A. Llompart-Pou
Jon Pérez-Bárcena
Josep M. Abadal
Javier Homar
Publication date: 01-12-2006
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 12/2006
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-006-0395-z

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Comment on “The Lund Concept for the treatment of severe head trauma—physiological principles and clinical application”

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