Major clinical and physiological benefits of early high doses of @entity2656 for intraparenchymal @entity548 with XXXX : a randomized trial.

@entity1 @entity2656 @entity101 @entity548 @entity2806 @entity26 @entity772 @entity2300
OBJECTIVE: We evaluated long-term clinical outcomes and postoperative physiological findings in acutely @entity772 @entity1 with nonmissile surgical intraparenchymal @entity548 and @entity2300 who received early preoperative high-dose @entity2656 (HDM) versus conventional dose @entity2656 treatment in the emergency room. METHODS: One hundred forty-one adult @entity1 with traumatic, nonmissile, acute, intraparenchymal @entity548 associated with early @entity2300 were prospectively and randomly assigned to receive emergency preoperative intravenous HDM treatment (approximately 1.4 g/kg; 72 @entity1 ) and were compared with a control group that was treated with a lower preoperative @entity2656 dose (approximately 0.7 g/kg; 69 @entity1 ). RESULTS: Early preoperative improvement of abnormal bilateral pupillary widening was significantly more frequent in the study group than in the control group (P < 0.03). The same was true for abnormal unilateral pupillary widening (P < 0.01). Early HDM treatment in the emergency room was also associated with significantly better 6-month clinical outcomes (P < 0.005). The two groups of @entity1 were well matched with respect to diameter of the @entity548 (approximately 4 cm) as well as timing of clot removal (approximately 2.5 hours after injury). Postoperative physiological findings revealed statistically significant between-group differences, with higher intracranial pressure and lower cerebral extraction of @entity26 (global relative cerebral hyperperfusion) in the control group than in the HDM group. @entity2806 (abnormally low arteriojugular lactate difference values) was rare and was found for less than 3% of the @entity1 in both groups. CONCLUSION: Early preoperative HDM administration in the emergency room was associated with improved clinical outcomes for @entity772 @entity1 with acute, nonmissile, intraparenchymal @entity548 and associated @entity2300 . Early improvement of bilateral or unilateral @entity2300 and better postoperative control of intracranial @entity101 and associated global relative cerebral hyperperfusion seemed to be relevant factors that were related to improved outcomes.
