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The "Lund Concept" for the treatment of severe head trauma - physiological principles and clinical application.

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Author

Summary, in English

The Lund Concept is an approach to the treatment of severe brain trauma that is mainly based on hypotheses originating from basic physiological principles regarding brain volume and cerebral perfusion regulation. Its main attributes have found support in experimental and clinical studies. This review explains the principles of the Lund Concept and is intended to serve as the current guide for its clinical application. The therapy has two main goals: (1) to reduce or prevent an increase in ICP (ICP-targeted goal) and (2) to improve perfusion and oxygenation around contusions (perfusion-targeted goal). The Lund therapy considers the consequences of a disrupted blood-brain barrier for development of brain oedema and the specific consequences of a rigid dura/cranium for general cerebral haemodynamics. It calls attention to the importance of improving perfusion and oxygenation of the injured areas of the brain. This is achieved by normal blood oxygenation, by maintaining normovolaemia with normal haematocrit and plasma protein concentrations, and by antagonizing vasoconstriction through reduction of catecholamine concentration in plasma and sympathetic discharge (minimizing stress and by refraining from vasoconstrictors and active cooling). The therapeutic measures mean normalization of all essential haemodynamic parameters (blood pressure, plasma oncotic pressure, plasma and erythrocyte volumes, PaO2, PaCO2) the use of enteral nutrition, and avoidance of overnutrition. To date, clinical outcome studies using the Lund Concept have shown favourable results.

Publishing year

2006

Language

English

Pages

1475-1484

Publication/Series

Intensive Care Medicine

Volume

32

Issue

10

Document type

Journal article review

Publisher

Springer

Topic

  • Anesthesiology and Intensive Care

Keywords

  • brain edema
  • penumbra
  • intracranial pressure
  • guideline
  • brain trauma
  • cerebral perfusion
  • brain volume regulation

Status

Published

ISBN/ISSN/Other

  • ISSN: 0342-4642