Correction of Systemic Hemodynamics and Gas Exchange in Patients with Severe Brain Injury

Abstract

Intensive care of patients with severe brain injury (SBI) should be performed, by taking into account damaging factors. The adequacy of correction of systemic hemodynamics and oxygen support in acute SBI determines the effectiveness of the performed treatment. Sixty-seven patients aged 21 to 68 years who had experienced SBI were examined and treated (28 patients were treated with the routine basic regimen and 39 were treated via goal-oriented correction of damaging factors). A comprehensive examination of the patients was made. The outcomes of therapy were assessed, by using the Glasgow coma scale (GCS). The episodes of hypoxia and arterial hypotension were detected in the virtually equal number of victims (as high as 90%) in both groups. The outcomes of therapy were better in patients without arterial hypotension. The mean blood pressure was maintained at a level of higher than 90 mm Hg; the volume of circulating blood was replenished. Endotracheal intubation was made in patients with depressed consciousness (less than 9 scores by GCS) if hypoxia was retained, which permitted controlled artificial ventilation to be performed. Amino acid drugs, fatty emulsions, hydroexyethyl starch preparations, and balanced enteral formulas were used to correct the internal environment. Goal-oriented correction of damaging factors in Group 2 reduced the number of poor outcomes and death rates.