Review

. 2015 Apr 21;19(1):186.

doi: 10.1186/s13054-015-0887-8.

Neuroprotection in acute brain injury: an up-to-date review

Nino Stocchetti^{1

2}, Fabio S Taccone³, Giuseppe Citerio^{4

5}, Paul E Pepe⁶, Peter D Le Roux⁷, Mauro Oddo⁸, Kees H Polderman⁹, Robert D Stevens¹⁰, William Barsan¹¹, Andrew I R Maas¹², Geert Meyfroidt¹³, Michael J Bell¹⁴, Robert Silbergleit¹⁵, Paul M Vespa¹⁶, Alan I Faden¹⁷, Raimund Helbok¹⁸, Samuel Tisherman¹⁹, Elisa R Zanier²⁰, Terence Valenzuela²¹, Julia Wendon²², David K Menon²³, Jean-Louis Vincent²⁴

Affiliations

¹ Department of Physiopathology and Transplant, Milan University, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F Sforza 35, 20122, Milan, Italy. stocchet@policlinico.mi.it.
² Neuro ICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F Sforza 35, 20122, Milan, Italy. stocchet@policlinico.mi.it.
³ Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, 1070, Brussels, Belgium. ftaccone@ulb.ac.be.
⁴ Department of Health Science, University of Milan-Bicocca, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy. g.citerio@hsgerardo.org.
⁵ NeuroIntensive Care, Department of Emergency and Intensive Care, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy. g.citerio@hsgerardo.org.
⁶ Department of Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 75390-8579, USA. Paul.Pepe@UTSouthwestern.edu.
⁷ Department of Neurosurgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA. LeRouxP@MLHS.ORG.
⁸ Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) University Hospital, Faculty of Biology and Medicine, University of Lausanne, 1011, Lausanne, Switzerland. Mauro.Oddo@chuv.ch.
⁹ Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA. poldermankh@upmc.edu.
¹⁰ Division of Neuroscience Critical Care, Division of Adult Critical Care, Johns Hopkins Medicine, Baltimore, MD, 21287, USA. rstevens@jhmi.edu.
¹¹ NETT Clinical Coordinating Center, University of Michigan, Ann Arbor, MI, 48106-0381, USA. wbarsan@med.umich.edu.
¹² Department of Neurosurgery, University Hospital Antwerp and University of Antwerp, 2650, Edegem, Belgium. andrew.maas@uza.be.
¹³ Department of Intensive Care, UZ Leuven, Campus Gasthuisberg, 3000, Leuven, Belgium. geert.meyfroidt@uzleuven.be.
¹⁴ Department of Critical Care Medicine and the Safar Center for Resuscitation Research, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA. bellmj4@upmc.edu.
¹⁵ NETT Clinical Coordinating Center, University of Michigan, Ann Arbor, MI, 48106-0381, USA. robie@med.umich.edu.
¹⁶ Department of Neurocritical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA. PVespa@mednet.ucla.edu.
¹⁷ Center for Shock, Trauma & Anesthesiology Research (STAR), University of Maryland School of Medicine, Baltimore, MD, 21201, USA. afaden@anes.umm.edu.
¹⁸ Department of Neurology, Neurocritical Care Unit, Innsbruck Medical University, 6020, Innsbruck, Austria. raimund.helbok@uki.at.
¹⁹ Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. tishermansa@ccm.upmc.edu.
²⁰ IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Department of Neuroscience, 20156, Milan, Italy. elisa.zanier@marionegri.it.
²¹ Department of Emergency Medicine, University of Arizona, Tucson, AZ, 85724-5057, USA. hermanos.valenzuela@gmail.com.
²² Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, UK. julia.wendon@kcl.ac.uk.
²³ Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK. dkm13@wbic.cam.ac.uk.
²⁴ Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, 1070, Brussels, Belgium. jlvincen@ulb.ac.be.

PMID: 25896893
PMCID: PMC4404577
DOI: 10.1186/s13054-015-0887-8

Review

Neuroprotection in acute brain injury: an up-to-date review

Nino Stocchetti et al. Crit Care. 2015.

. 2015 Apr 21;19(1):186.

doi: 10.1186/s13054-015-0887-8.

Authors

Affiliations

¹ Department of Physiopathology and Transplant, Milan University, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F Sforza 35, 20122, Milan, Italy. stocchet@policlinico.mi.it.
² Neuro ICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F Sforza 35, 20122, Milan, Italy. stocchet@policlinico.mi.it.
³ Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, 1070, Brussels, Belgium. ftaccone@ulb.ac.be.
⁴ Department of Health Science, University of Milan-Bicocca, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy. g.citerio@hsgerardo.org.
⁵ NeuroIntensive Care, Department of Emergency and Intensive Care, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy. g.citerio@hsgerardo.org.
⁶ Department of Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 75390-8579, USA. Paul.Pepe@UTSouthwestern.edu.
⁷ Department of Neurosurgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA. LeRouxP@MLHS.ORG.
⁸ Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) University Hospital, Faculty of Biology and Medicine, University of Lausanne, 1011, Lausanne, Switzerland. Mauro.Oddo@chuv.ch.
⁹ Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA. poldermankh@upmc.edu.
¹⁰ Division of Neuroscience Critical Care, Division of Adult Critical Care, Johns Hopkins Medicine, Baltimore, MD, 21287, USA. rstevens@jhmi.edu.
¹¹ NETT Clinical Coordinating Center, University of Michigan, Ann Arbor, MI, 48106-0381, USA. wbarsan@med.umich.edu.
¹² Department of Neurosurgery, University Hospital Antwerp and University of Antwerp, 2650, Edegem, Belgium. andrew.maas@uza.be.
¹³ Department of Intensive Care, UZ Leuven, Campus Gasthuisberg, 3000, Leuven, Belgium. geert.meyfroidt@uzleuven.be.
¹⁴ Department of Critical Care Medicine and the Safar Center for Resuscitation Research, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA. bellmj4@upmc.edu.
¹⁵ NETT Clinical Coordinating Center, University of Michigan, Ann Arbor, MI, 48106-0381, USA. robie@med.umich.edu.
¹⁶ Department of Neurocritical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA. PVespa@mednet.ucla.edu.
¹⁷ Center for Shock, Trauma & Anesthesiology Research (STAR), University of Maryland School of Medicine, Baltimore, MD, 21201, USA. afaden@anes.umm.edu.
¹⁸ Department of Neurology, Neurocritical Care Unit, Innsbruck Medical University, 6020, Innsbruck, Austria. raimund.helbok@uki.at.
¹⁹ Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. tishermansa@ccm.upmc.edu.
²⁰ IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Department of Neuroscience, 20156, Milan, Italy. elisa.zanier@marionegri.it.
²¹ Department of Emergency Medicine, University of Arizona, Tucson, AZ, 85724-5057, USA. hermanos.valenzuela@gmail.com.
²² Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, UK. julia.wendon@kcl.ac.uk.
²³ Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK. dkm13@wbic.cam.ac.uk.
²⁴ Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, 1070, Brussels, Belgium. jlvincen@ulb.ac.be.

PMID: 25896893
PMCID: PMC4404577
DOI: 10.1186/s13054-015-0887-8

Abstract

Neuroprotective strategies that limit secondary tissue loss and/or improve functional outcomes have been identified in multiple animal models of ischemic, hemorrhagic, traumatic and nontraumatic cerebral lesions. However, use of these potential interventions in human randomized controlled studies has generally given disappointing results. In this paper, we summarize the current status in terms of neuroprotective strategies, both in the immediate and later stages of acute brain injury in adults. We also review potential new strategies and highlight areas for future research.

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Figures

**Figure 1**
**Neuroprotective strategies in the ICU.** To avoid further insults to the brain (NMR image of a normal brain at the center), the goals of intensive care management are to ensure adequate oxygen delivery and to avoid excessive oxygen consumption, as in epileptic crises and cases of high brain temperature. See text for details on reperfusion after ischemic stroke, optimal hemoglobin level, and desirable cerebral perfusion pressure (CPP) levels. ICP, intracranial pressure; MAP, mean arterial pressure; PaO₂, arterial oxygen tension.

See this image and copyright information in PMC

References

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Neuroprotection in acute brain injury: an up-to-date review

Affiliations

Neuroprotection in acute brain injury: an up-to-date review

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical