Honeybul S., Kolia A.G. Traumatic Brain Injury: Science, Practice, Evidence and Ethics

New York: Springer, 2021. — 347 p.This book provides a comprehensive analysis of the contemporary management of all aspects of traumatic brain injury (TBI), combining the findings of several recent randomized controlled trials investigating the role of hypothermia, erythropoietin, intracranial pressure monitoring, and decompressive craniectomy in the management of TBI.The book is divided into four sections: the first section covers the epidemiology of TBI, the changing global patterns of presentation, and the basic pathophysiology and classification, while the second discusses contemporary management of TBI, from pre-hospital care, emergency assessment, and medical and surgical management to rehabilitation and social reintegration. The third section then examines the evidence gained from recent clinical trials that have investigated the efficacy of management strategies involving intracranial pressure monitoring, multimodal monitoring, hypothermia, erythropoietin, thromboembolic prophylaxis, and decompressive craniectomy. Lastly, the fourth section explores the ethical issues, both at the societal level and on an individual basis.Written by a broad range of experts, this book provides a valuable reference resource for neurosurgeons, intensivists, clinicians with ethical experience, and pure bioethicists in their daily work.Part I: Scientific Background.
: Epidemiology of Traumatic Brain Injury.Defining Traumatic Brain Injury.
Classifying Traumatic Brain Injury.
The Incidence of Traumatic Brain Injury.
The Severity of Traumatic Brain Injury.
Financial Perspective.
Risk Factors for TBI.
Traumatic Brain Injury in HICs.
Traumatic Brain Injury in LMICs.
Traumatic Brain Injury in the Military.
Preventive Strategies.: Pathophysiology of Traumatic Brain Injury.Acute Pathophysiology.
Consequences of Mechanical Force and Deformation.
Ionic and Metabolic Disruption.
Diffuse Axonal Injury.
Vascular Disruption and Dysfunction.
Inflammation.
Altered Neural Circuitry.
Chronic Pathophysiology.: Mechanics of Brain Tissue Deformation and Damage Following Trauma.Overview of Healthy Brain Mechanics.
Material Modeling of Brain Tissue.
Macroscale Modeling of the Brain.
Microscale Tissue Damage Induced by TBI.
Direct Observations of Tissue Damage from Experiments.
Inferring Tissue Damage from Experiments Combined with Modeling.
Predicting and Modeling Tissue Damage.
Macroscale Deformation in the Brain Induced by TBI.
Future Directions.: Evidence Pyramid, Comparative Effectiveness Research, and Randomised Trials.
Introduction: What Constitutes ‘Evidence’?
Background Information: Pros and Cons of Different Paradigms of Evidence.
Illustrative Cases: The Story of Decompressive Craniectomy.
Recent Developments: Comparative Effective Research.
Future Directions.: Big Data Collection and Traumatic Brain Injury.What Is Big Data in TBI?
Collection of Big Data.
Use of Big Data in TBI.
Classification of TBI.
Acute TBI Management.
ICP Monitoring.
Intravenous (IV) Fluids and Medication Adjustments.
Supportive Information to Guide Management.
Management of Chronic TBI.
Research Applications.
Strengths and Limitations.
Future Directions.Part II: Current Clinical Practice.
: Prehospital and Emergency Department Management of TBI.Background Information and Pathophysiology.
Current Evidence and Contemporary Practice.
Pitfalls.
Future Directions.: Monitoring the Injured Brain.Current Evidence and Contemporary Practice.
Clinical Evaluation.
Intracranial Pressure Monitoring.
Prediction: ICP Prediction of Poor Outcome and Threshold for Intervention.
Perfusion: Optimal Cerebral Perfusion Pressure.
Pathology: Early Detection of Mass Lesions.
ICP Monitoring: Current Evidence.
Cerebral Oxygenation Monitoring.
Jugular Bulb Venous Oxygen Saturation Monitoring (SjvO).
Brain Tissue Oxygen Tension Monitoring (PbtO).
Near-Infrared Spectroscopy (NIRS).
Microdialysis (MD).
Brain Ultrasonography: B-Mode Transcranial Color-Coded Duplex (TCCD) and Transcranial Doppler (TCD) Sonography.
Thermal Diffusion Flowmetry.
Ultrasound of Optic Nerve Sheath Diameter.
Neurophysiological Monitoring.: Contemporary Medical Management of Traumatic Brain Injury: High-Income Countries.Neuroprotective Therapy.
Multimodal Monitoring.
Monro-Kellie Doctrine.
Contemporary Medical Management of Severe Traumatic Brain Injury.
Initial Medical Management in the ICU.
Tier.
Hyperosmolar Therapy.
Tier.
Hyperventilation.
Neuromuscular Blocking Agents.
Assessment of Autoregulation and Optimizing Cerebral Perfusion Pressure (CPP).
Tier.
Hypothermia.
Barbiturate Coma.
Decompressive Craniectomy.: Contemporary Management of Traumatic Brain Injury: Low and Middle-Income Countries.Background Information and Historical Aspects.
Current Evidence, Contemporary Practice, and Ethical Issues.
Future Directions.
Addressing the Training Deficit in Neurotrauma Care.
Societal Considerations.: Contemporary Surgical Management of Traumatic Brain Injury.Assessment of Conscious Level.
Surgical Procedures.
Skull Fractures.
Types of Fractures.
Diagnostic Exams.
Surgical Treatment.
Posttraumatic Intracerebral Hematoma.
Acute Extradural Hematoma.
Surgical Treatment.
Hyperacute Decompression.
Acute Subdural Hematoma.
Surgical Treatment.
Cerebral Contusions.
Surgical Treatment.
Penetrating Brain injury.
Radiological Evaluation.
Traumatic Cerebrospinal Fistula.
CSF Fistula: Presentation.
CSF Fistula: Localization.
Nonsurgical Treatment.
Surgical Treatment.
Intracranial Surgical Approaches.
Endoscopic Endonasal Approaches.: Military Management of Traumatic Brain Injury.History of Military Approach to TBI.
Severe and Penetrating TBI.
Mild TBI.
Contemporary Practice.
TBI Grading.
Roles of Care.
Severe and Penetrating TBI.
Mild TBI.
Future Directions.: Contemporary Management of Paediatric Head Injuries.Anatomical and Pathophysiological Differences in Children Relevant to TBI.
Characteristics of Primary TBI in Children.
Skull Fractures.
Intracranial Haematomas.
Diffuse Axonal Injury (DAI).
Secondary TBI in Children.
Non-Accidental Injury (NAI).
Birth Injuries.
Management of Traumatic Brain Injury.
Mild TBI.
Moderate and Severe TBI.
Initial Management of Paediatric Patients in the ICU.
Tier.
Tier.
Tier Therapies.
Hypothermia.
Barbiturate Coma.
Decompressive Craniectomy.
Future Directions.: Sports-Related Traumatic Brain Injury.Background Information and History.
Management and Long-Term Consequences of SRC.
SRC Recognition and Diagnosis.
Early Removal from Play and Graduated Return-to-Play (or School) Protocol.
Concussion Recovery and the “Post-Concussion Syndrome”.
Long-Term Consequences.
Future Directions.
Controversies.
Prevention.
Fluid Biomarkers.
Acute Treatment.
Neuroimaging.
Magnetic Resonance Imaging (MRI).
Positron Emission Tomography.
When Should a Career Be Terminated?: Rehabilitation After Traumatic Brain Injury.Historical Perspective of TBI Rehabilitation.
Classification of Disability and Health.
Rehabilitation Pathways and Services.
Rehabilitation Prescriptions.
The Multidisciplinary Approach.
Physiotherapy.
Occupational Therapy.
Speech and Language Therapy.
Neuropsychology.
Rehabilitation Medicine Physicians.
Goal Setting.
Brain Injury and the Mental Capacity Act.
Cognitive Impairment and Recovery After Traumatic Brain Injury.
Vocational Rehabilitation After Brain Injury.
Emerging Trends in Rehabilitation.
Deep Brain Stimulation.
Augmented Reality.
Brain-Computer Interface.Part III: Evidence.
: Predicting Outcome Following Traumatic Brain Injury.Background Information on Prognostic Factors of TBI.
Recent Developments.
Future Directions.: Biomarkers in Traumatic Brain Injury.
Introduction: The Need for Biomarkers in TBI Medicine.
Challenges in Developing Biomarkers for Clinical Use in TBI.
The Role of Biomarkers in Specific Clinical Situations.
Identifying Patients with Mild Traumatic Brain Injury.
Assessing the Need for Imaging After Mild Traumatic Brain Injury.
Outcome Prediction.
Monitoring the Injured Brain.
Current Evidence.
Protein Biomarkers.
Neuronal Cell Body Biomarkers.
Neuron-Specific Enolase (NSE).
Ubiquitin C-Terminal Hydrolase-L (UCH-L).
Axonal and Axon Terminal Biomarkers.
Neurofilament Light Polypeptide (NF-L).
Tau.
Astroglial Biomarkers.
Glial Fibrillary Acidic Protein (GFAP).
S Calcium-Binding Protein B (SB).
Metabolomic and Lipidomic Biomarkers.
Future Directions and Conclusions.: Erythropoietin, Progesterone, and Amantadine in the Management of Traumatic Brain Injury: Current Evidence.Erythropoietin.
Progesterone.
Amantadine.
Future Directions.: Tranexamic Acid in the Management of Traumatic Brain Injury.Coagulation and Coagulopathy in Traumatic Brain Injury.
Tranexamic Acid.
Tranexamic Acid: Current Evidence for Efficacy.
The CRASH- Trial.
The Subgroup Analysis.
CRASH- Trial Interpretation.
Future Directions.: Hypothermia in the Management of Traumatic Brain Injury.History of Therapeutic Hypothermia.
The Pathophysiology of Traumatic Brain Injury.
The Monro-Kellie Doctrine.
Neuroprotection and the Heterogeneity Paradox.
Hypothermia: Clinical Evidence.
Future Directions.
Management Strategies.
Complications.: Decompressive Craniectomy in the Management of Traumatic Brain Injury.Background Information.
History.
Pathophysiology.
Practical Aspects: Surgical Techniques, Indications and Patient Selection.
Hemicraniectomy.
Bifrontal Decompressive Craniectomy.
Indications.
Patient Selection.
After Decompressive Craniectomy.
Specific Aspects of Care After Decompressive Craniectomy.
Complications.
Cranial Reconstruction.
Current Evidence Base.
DECRA Trial.
RESCUEicp Trial.
Other Trials of Decompressive Craniectomy.
Summarizing the Current Evidence Base and Its Limitations.
Patient Values and Preference.: Cranioplasty Following Traumatic Brain Injury.Cranioplasty: Clinical Indications.
Restoration of Cosmesis.
Regaining Protection of the Cerebral Tissue.
Re-establishment of Normal Cerebral Hydrodynamics.
Cranioplasty: Surgical Technique.
Surgical Timing.
Management of Temporal Muscle.
Materials Used for Reconstruction.
Autologous Bone.
Titanium.
Methyl Methacrylate.
Ceramics and Others.
Current Evidence.
Complications of Cranioplasty.
Sudden Death.
Postoperative Collections.
Infection.
Bone Resorption.
Future Directions.: Thromboembolic Prophylaxis in Traumatic Brain Injury.Background Information and Pathophysiology.
Current Evidence and Recommendations.
Future Directions.: Long-Term Neurological Consequences of Traumatic Brain Injury.Long-Term Behavioral Issues.
Long-Term Physical Symptoms Following TBI.
Long-Term Cognitive Symptoms Following TBI.
Long-Term Emotional Symptoms Following TBI.
Long-Term Neurodegenerative Problems.
Dementia Following TBI: Historical Evidence and Case Studies.
Chronic Traumatic Encephalopathy.
Impaired Cognition in Later Life: Epidemiological Evidence.
Cognitive Decline of TBI: Future Developments.: Post-Traumatic Epilepsy.Epidemiology.
Pathophysiology.
Oxidative Stress.
Excitotoxic Mechanism.
History and Examination.
Investigations.
Magnetic Resonance Imaging.
Current Evidence.
Specific Antiepileptic Medications.
Non-pharmacological Interventions.
Future Directions.: Brain Death: Current Evidence and Guidelines.Definition of Death.
Pathophysiology and Mechanisms of Brain Death.
Essential Prerequisites for the Diagnosis of BD/DNC.
BD/DNC: The Clinical Diagnosis.
Ancillary Tests.
Pediatric Considerations.
The Role of Communication and of Education and Training.Part IV: Ethical Considerations.
: Introduction to Bioethics.The History of Bioethics.
Virtue Ethics: Greek.
Virtue Ethics: Christian.
Natural Law.
Deontology and Kantian Ethics.
Utilitarianism and Consequentialism.
Feminist Ethics.
Contemporary Ethical Frameworks.: Consent for Neurosurgery in Cases of Traumatic Brain Injury.Consent.
Capacity to Consent to Treatment.
Consent Must Be Voluntary and Free from Undue Influence.
Consent Should Be Accompanied by the Provision of Information Regarding Material Risks.
The Ethical and Legal Limits of Consent.
Disputes over Treatment.
A Clinical Example.
Discussion.: Team-Based Decision-Making in Traumatic Brain Injury.History of Shared Decision-Making.
Agency for Healthcare Research and Quality (AHRQ) SHARE Approach to SDM.
SDM Foundation.
SDM Challenges.
SDM Conflicts.
Conflicts for Physicians.
Conflicts for Family Members.
SDM Drivers.
SDM Types.: Traumatic Brain Injury and Resource Allocation.Contextual Considerations on Resource Limits.
How Do Limited Resources Apply to Traumatic Brain Injury (TBI)?
Framework for Priority Setting in Clinical Care.
How Does Resource Allocation Affect TBI?: Research Ethics in Clinical Trials.Clinical Trials in Neurotrauma.
The Role of Corticosteroids in the Management of TBI.
The Role of Therapeutic Hypothermia in the Management of Traumatic Brain Injury.
Hypothermia: Clinical Studies.
The Role of Decompressive Craniectomy in Severe Traumatic Brain Injury.
The DECompressive CRAniectomy (DECRA) Trial.
The Randomised Evaluation of Surgery with Elevation of Intracranial Pressure (RESCUEicp) Trial.
The Role of ICP Monitoring in the Management of TBI.
The Role of Tranexamic Acid in TBI.: Artificial Intelligence and Healthcare Ethics.Ethical Outlook.
Pathway for Ethical Healthcare.
Transparency, Responsibility, and Reproducibility.
Autonomy in AI (Scope of Human Intervention).
Privacy and Security.
Social Impact.
Machines with Morality.
Deployment and AI Safety.: Ethical Issues in Paediatric Traumatic Brain Injury.Background Information.
Current Evidence.
Communication and Consent in Paediatric Neurotrauma.
Brain Death.: Withholding and Withdrawing Treatment.Withdrawing Medical Therapy: Historical Aspects.
Withdrawing and Withholding Medical Therapy: Traumatic Brain Injury.
Treatment Decisions for Incapacitated Patients.
Consent.
Medical Futility.
Medical Futility: An Alternative Approach.
Medical Futility: Does Life Have Intrinsic Value?
Withholding and Withdrawing Life-Sustaining Treatment: Is There a Difference?
Acts and Omissions.
The Equivalence Test.
Practical Decision-Making.
Mitigating Conflict.: Long-Term Outcome Following Traumatic Brain Injury.Favorable Outcome but Not Necessarily Acceptable.
Unfavorable Outcome but Not Necessarily Unacceptable.
The Disability Paradox.
The Salutogenic Model.
Unfavorable and Unknown.
Disorders of Consciousness: Diagnosis.
Disorders of Consciousness: Experimental Intervention.
The Rule of Rescue.
Disorders of Consciousness: Surgical Intervention.