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A Summary Of Meta-Analysis

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A meta-analysis performed by Gu et al compared the safety and efficacy of propofol with midazolam for sedation of patients with severe traumatic brain injury. Gu et al performed this meta-analysis because of the lack of systematic reviews or meta-analysis available, which focus on TBI patients in the comparison of the safety and efficacy of propofol and midazolam.

The analysis involved four small, randomised controlled trials that compared the impact of the two drugs on ICP and cerebral perfusion pressure (CPP). Two of these studies also included the impact the two drugs had on mortality and GOS.

After eight days in the neurotrauma unit, Mr Smith’s raised intracranial pressure (ICP) remained refractory to medical intervention and
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While Mr Smith had a DC performed as a last-tier intervention, DC may also be performed as an early intervention. Two recent randomised controlled trials have compared the effectiveness of DC to reduce ICP and mortality compared with medical intervention alone. Cooper et al performed the Decompressive Craniectomy in Diffuse Traumatic Brain Injury (DECRA) Trial in 2011. The DECRA Trial had a cohort of 155 patients, aged 15 to 59 years old, with severe, nonpenetrating, traumatic brain injury (TBI), calculated by a GCS of equal or less than eight.

To meet criteria the cohort needed an ICP of 20 mmHg or greater for a minimum of 15 minutes after first-tier medical intervention. Once the cohort was randomised into a medical group and a surgical group, the surgical group had DC performed within 72 hours.

Early results found the DC group required less intervention to achieve a lower ICP than the receiving medical intervention alone. The DC group also had a shorter duration of intubation and earlier Intensive Care Unit (ICU) discharge, however this did not change the overall duration of hospital admission. At the six months follow-up, 70 percent of patients in the DC group presented with unfavourable outcomes, categorised as ranging from one to four on the Extended Glasgow Outcome Scale (GOS-E). This gave an odds ratio of
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