Protective sedation during transportation of patients with brain damage

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Introduction. Transporting a patient with brain and skull damage is a difficult and demanding task for the medical service. Despite the fact that the systematic approach to transportation is based on the principle of ACCEPT (Assessment, Control, Communication, Evaluation, Preparation and Packing, Transportation), a number of unresolved problems remain, which may complicate the implementation of urgent measures and additionally affect the patient's condition and treatment results.
These include:
• incomplete medical care at the transportation stage;
• an unspecified time factor, which may lead to a delay in the patient's delivery to a medical facility;
• deterioration of the patient's condition during transportation (cerebral edema, increased intracranial pressure, impaired breathing and circulation);
• additional stressors (vibrations, slopes, turbulence) contributing to the deterioration of the overall clinical picture.
This determines the need to improve the organization of medical care, improve the skills of medical personnel, optimize, taking into account the individual characteristics of the patient's treatment methods, develop tactics to eliminate factors that contribute to the deterioration of his condition and negatively affect the results of treatment.
Objective: to optimize the tactics of transporting a patient with a traumatic brain injury on the route.
Materials and methods. A retrospective chart review was conducted of 21 patients with neurosurgical trauma with uncontrolled intracranial pressure (ICP) hospitalized in the Department of Traumatology/intensive care. Barbiturates (propofol, thiopental, pentobarbital, etc.) were used as sedatives. ICP was monitored at all stages of evacuation in patients in a state of barbiturate-controlled coma. High-resolution monitoring data were used to study the effect of barbiturate coma on ICP, mean blood pressure, cerebral perfusion pressure and intracranial compensatory reserve index. Four half-hour periods were studied: before bolus injection and 5, 10 and 24 hours after that, respectively, and the fifth period of narrowing with S-thiopental from < 100 to < 30 mmol/L. Concentrations of S-thiopental and administered doses were recorded.
Results and discussions. Based on the results obtained, at least 67% of patients had ICP indicators that remained stable at all stages of evacuation. This confirmed the effectiveness of the tactics used to ensure the evacuation of patients with neurosurgical trauma in a barbiturate coma.
When conducting the study, we took into account the likelihood of developing recurrent concussion syndrome. It is determined by a sudden increase in ICP, and sometimes fatal after a second traumatic stroke, which occurs before a full sustained recovery from a minor head injury. It is associated with a loss of autoregulation of cerebral circulation, which leads to vascular overflow and an uncontrolled increase in ICP. At the same time, barbiturate coma acts as a protective sedation, as a method of preventing the development of this kind of complication during transportation of patients with neurosurgical trauma.
In addition, based on the data of a retrospective study, it was found that the survival rate of patients undergoing ICP control and correction with barbiturate coma was better than in those patients who did not use this tactic (71% vs. 14%, p = 0.021).
Thus, therapy with high doses of barbiturates is an effective method of preventing the development of complications during transportation, helps to increase survival and reduce mortality in patients with neurosurgical injuries.

Conclusion.
Analyzing the obtained research results, we can confirm the effectiveness of the tactics used to ensure the evacuation of patients with neurosurgical trauma in a barbiturate coma. Protective sedation takes place in the practice of transporting patients with traumatic brain injury, aimed at preserving metabolic processes, full control of the patient's condition, reducing the threat of secondary damage and undesirable complications

About the authors

Yaroslava Andreyevna Butko

Donetsk State Medical University named after M. Gorky

Email: kochka777666@mail.ru

Student

Russian Federation, Donetsk city, Ilyich street 16

Nikita Andreevich Anosov

Donetsk State Medical University named after M. Gorky

Email: anosov18042001@gmail.com

Student 

Russian Federation, Donetsk city, 16 Ilyich Street

Oleg Vladimirovich Demchuk

Donetsk National Medical University named after M. Gorky

Author for correspondence.
Email: Kochka777666@mail.ru

MD, Head of the Department of Emergency Medicine and Extreme Medicine

Russian Federation, Donetsk city, 16 Ilyich Street

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