Sposoby leczenia urazu głowy

Tier 3 therapy

Failure of fluid therapy, oxygenation and ventilation strategies and osmotic diuretics to stabilise the patient and or improve the neurological status significantly warrants radical therapy and such cases should be considered for advanced imaging such as MRI. The treatments discussed below have not been evaluated in veterinary medicine in terms of their efficacy and remain controversial or unproven in human head trauma.

Hyperventilation

Hyperventilation has been suggested as a method of quickly lowering ICP. Hypercapnia causes vasodilation and subsequent increases in intracranial pressure; therefore, hypoventilation should be avoided. Mechanical or manual ventilation may be used to lower partial pressure of carbon dioxide in the arterial blood (PaCO₂ < 35 mmHg) to reduce ICP in deteriorating patients responsive to no other treatment and with no surgical lesions. The prolonged use of hyperventilation should be avoided as reduction in cerebral PaCO₂ less than 30-35 mmHg causes vasoconstriction which ultimately lead to decreased cerebral blood flow and ischaemia.

Surgery

Surgical intervention is reserved for patients that do not improve or deteriorate despite aggressive medical therapy. Advanced imaging (CT or MRI) is necessary for surgical planning and is also reserved for similar patients. Surgery may be indicated to remove hematomas, relieve intracranial pressure, or address skull fractures. Ventricular obliteration and mass effect identified on advanced [...]

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