Diffüz Aksonal Yaralanması Olan Hastada Prognoz: Anestezi, Yoğunbakım ve Rehabilitasyon Yönetimi
Synopsis
Diffuse Axonal Injury (DAI) is a severe form of traumatic brain injury associated with high mortality and morbidity, characterized by widespread damage to axons in the brain resulting from acceleration and deceleration forces. The condition leads to significant systemic effects across the cardiovascular, respiratory, gastrointestinal, metabolic, and neurological systems. In the acute phase, prognostic evaluation of the patient is conducted using the Glasgow Coma Scale (GCS) and the APACHE II score, which exhibits higher specificity in predicting ICU necessity and survival odds; long-term functional outcomes and quality of life are predicted using the Glasgow Outcome Scale (GOS), Extended GOS (GOSE), and QOLIBRI scales. In anesthesia and intensive care management, the primary goal is to preserve cerebral perfusion pressure without increasing intracranial pressure (ICP), ensuring normocapnia (PaCO2 35-45 mmHg) and adequate oxygenation. Airway management requires rapid sequence intubation, while anesthetics that maintain hemodynamic stability such as propofol or etomidate should be preferred; prophylactic hyperventilation and nitrous oxide use must be avoided to prevent ICP spikes and cerebral ischemia. Fluid resuscitation should utilize isotonic crystalloids while avoiding Lactated Ringer's and hypotonic solutions. For ICP management, head elevation by 30 degrees, osmotic diuresis using mannitol or hypertonic saline, and CSF drainage can be employed. Finally, initiating personalized physiotherapy and rehabilitation at an early stage is vital to prevent musculoskeletal deformities, spasticity, and respiratory complications while facilitating neurological recovery.
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