IMPACT OF SEDATION IN TBI PATIENT

Impact of Sedation in Traumatic Brain Injury Patient

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Impact of Sedation in Traumatic Brain Injury Patient

Introduction

TBI (Traumatic brain injury) remains a major public health problem, even with modern medicine in the 21st century. Majority patients with traumatic brain injury (75-80 percent) have mild cranium injuries, other injuries are equally divided between severe and moderate categories.

TBI cost to society is astonishing, both economically and emotionally. Approximately 100 percent of individuals with severe head trauma and as many as two thirds of patients with moderate TBI and will be permanently disabled in some way and not return to their premorbid level of function. In the US, the direct cost of care with traumatic brain injury patients, excluding hospital care is projected over $ 25 billion a year.

TBI is associated with catecholamines resulting in an increased risk of mortality and infectious morbidity. Berkenbosch, et.al, the addition of multiple beta-blockers doses considerably reduces the risk of death and drastically improves the probability of survival for patients (Berkenbosch, et.al, 2004). Sedation refers to the reduction of agitation or irritability by sedative drugs administration, to facilitate a procedure of diagnosis.

This paper examines the impact of sedation in TBI patient. The purpose of this literature review is to scrutinize present research to prop up sedation assessment scales use for evaluating sedation in the TBI patient. Sedative administration is essential in the severe care unit to assist mechanical ventilation and interventions tolerance. This paper also examines sedatives use in TPI patient can aid in controlling intracranial pressure and reducing neurological injury, but the inappropriate sedative consequences can be deadly.

Discussion

Literature Review

Several researches have been conducted to identify the impact of best sedatives to treat traumatic brain injury. A systematic review did not find any evidence that a sedative is better than other for improving neurological findings or death in seriously unwell adults with severe TBI. The major impacts of sedation in Traumatic Brain Injury Patient includes improve patient comfort, minimize noxious stimuli, reducing the metabolic requirements of the brain damaged to avoid the progression of ischemic injury traumatic in the presence of improved ICP, evade ICP increase due to airway instrumentation including those induced by means of coughing, and assist mechanical ventilation to control PaCo2 (Ebert, et.al., 2005).

Sedation usually improved CPP (cerebral perfusion pressure) and ICP (intracranial pressure) against baseline in most assessments. Interestingly short or bolus opioids infusions as a result (often ephemeral) decreased MAP, increased ICP and CPP in three randomized clinical trials. A supplementary editorial proposes that this might be due to heavy doses of opioids (3 µg/kg of fentanyl) and ensuing hypotension; hypotension itself may activate cerebral vasodilation, and CPP decrease and increase ICP. While opioids have been associated with an increase in ICP by decreasing resistance of cerebrovascular, increase in Paco2 or cerebral blood flow, and impaired cerebral autoregulation, they affirm that in researches that have prevented the hypotension after administration of opiates, an effect of increased ICP are visible.

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