Neurocritical Care

Hypothermia during TBI may also reduce the induction of hepatic metabolism/cause metabolic

rate of medications to be less than baseline.

Augmented renal clearance

Increase in glomerular filtration rate (e.g., CrCL greater than 120 mL/min)

Fluid resuscitation

Increased endogenous catecholamines and glucocorticoid response

Increased dosing requirement for commonly used agents such as vancomycin, aminoglycosides,

β-lactams (J Trauma Acute Care Surg 2016;81:1115-21; Neurocrit Care 2015;23:374-9; Clin

Augmented renal clearance tends to subside over time (usually after first 7–10 days, but varies by

patient).

About 8%–33% incidence in survivors of acquired brain injury

lesions), but may occur with other CNS insults

Typically, a diagnosis of exclusion and includes three or more symptoms in a cyclic fashion or

episodically when the patient is stimulated (Baguley 2014).

Fever

Tachycardia

Hypertension

Dyspnea

Diaphoresis

Muscle rigidity (posturing)

Pain

Bladder distension

Turning

Typically unprovoked (hence “paroxysmal”)

activity of brain stem after brain injury

PSH at that specific time has two components – Diagnosis Likelihood Tool and Clinical Feature Scale (J

Neurotrauma 2014;31:1515-20)