Peter J. Hutchinson

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BACKGROUND Chronic subdural haematoma causes serious morbidity and mortality. It recurs after surgical evacuation in 5-30% of patients. Drains might reduce recurrence but are not used routinely. Our aim was to investigate the effect of drains on recurrence rates and clinical outcomes. METHODS We did a randomised controlled trial at one UK centre between(More)
OBJECTIVE To use a range of techniques to explore diffusion limitation as a mechanism of cellular hypoxia in the setting of head injury. DESIGN A prospective interventional study. SETTING A specialist neurocritical care unit. PATIENTS Thirteen patients within 7 days of closed head injury underwent imaging studies. Tissue for ultrastructural studies(More)
Secondary insults can adversely influence outcome following severe traumatic brain injury. Monitoring of cerebral extracellular chemistry with microdialysis has the potential for early detection of metabolic derangements associated with such events. The objective of this study was to determine the relationship between the fundamental biochemical markers and(More)
Important advances have been made in understanding the mechanisms of secondary brain damage in patients with severe head injury. Attempts to interfere pharmacologically with these mechanisms have so far been unsuccessful. Hypothermia has been used as a method of brain protection in a clinical setting in patients with traumatic brain injury for many years.(More)
OBJECTIVES We have sought to develop an automated methodology for the continuous updating of optimal cerebral perfusion pressure (CPPopt) for patients after severe traumatic head injury, using continuous monitoring of cerebrovascular pressure reactivity. We then validated the CPPopt algorithm by determining the association between outcome and the deviation(More)
OBJECTIVE In this study we have used O positron emission tomography, brain tissue oxygen monitoring, and cerebral microdialysis to assess the effects of cerebral perfusion pressure augmentation on regional physiology and metabolism in the setting of traumatic brain injury. DESIGN Prospective interventional study. SETTING Neurosciences critical care unit(More)
OBJECTIVE To determine the effect of normobaric hyperoxia on cerebral metabolism in patients with severe traumatic brain injury. DESIGN Prospective clinical investigation. SETTING Neurosciences critical care unit of a university hospital. PATIENTS Eleven patients with severe traumatic brain injury. INTERVENTIONS Cerebral microdialysis, brain tissue(More)
Energy metabolism in the human brain is not fully understood. Classically, glucose is regarded as the major energy substrate. However, lactate (conventionally a product of anaerobic metabolism) has been proposed to act as an energy source, yet whether this occurs in man is not known. Here we show that the human brain can indeed utilize lactate as an energy(More)
Antemortem demonstration of ischemia has proved elusive in head injury because regional CBF reductions may represent hypoperfusion appropriately coupled to hypometabolism. Fifteen patients underwent positron emission tomography within 24 hours of head injury to map cerebral blood flow (CBF), cerebral oxygen metabolism (CMRO2), and oxygen extraction fraction(More)
Microdialysis is used in many European neurointensive care units to monitor brain chemistry in patients suffering subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI). We present a consensus agreement achieved at a meeting in Stockholm by a group of experienced users of microdialysis in neurointensive care, defining the use of microdialysis,(More)