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Last month we talked about hypotension in head trauma. In this critical care mailbag, Scott lays out his optimal management of post intubation care of the head injured patients.
Lily M. - January 7, 2017 8:42 AM
Are these goal SPO2 values based on sea level? Should it change for patients at 6,000 feet?
Kaitlin G. - January 11, 2017 7:05 AM
Thanks for having this topic! I was surprised to here that we should be targeting sBPs of 140-160 in traumatic head injuries. I am aware of the current guidelines regarding the management of hypertension in the setting of spontaneous ICH (although the evidence for these guidelines are lukewarm at best, especially in light of the ATTACH II trial ). However, with regards to traumatic ICH, the 2016 Brain Trauma Foundation do not mention anything about lowering BP, and it was my understanding that HTN in the setting of traumatic ICH is generally thought to reflect physiologic compensation in order to maintain CPP. Of course, if HTN is in the setting of cushing's or a blown pupil, then the patient should be treated with mannitol, hypertonic saline, or surgical decompression (but not antihypertensives). I would be really interested to read any studies that support lowering BP in the setting of traumatic ICH. Thank you!
robert k. - April 3, 2017 2:24 PM
my institution uses fentanyl drips for sedation and not propofol anymore. we are part of a 5 hospital system including
a level 1 trauma center.
scott, can you explain why your icu/institution uses dexmedetomidine instead of fentanyl
for your icu sedation.
many thanks,
rob k