ReviewFrontiers in neurology2017
Critical Evaluation of the Lund Concept for Treatment of Severe Traumatic Head Injury, 25 Years after Its Introduction.
Review in Frontiers in neurology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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Who cites it
22 citing papers in PubMed.
- Decompressive craniectomy in traumatic brain injury: insights from a 15-year multicentre cohort in Sweden.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Article
- Predictive Value of the Lowest Serum Albumin Level During Hospitalization in Patients With Intracerebral Hemorrhage.Neurology research international · 2026Article
- A Comprehensive Review of Fluid Resuscitation Strategies in Traumatic Brain Injury.Journal of clinical medicine · 2025Review
- The influence of hemorrhagic shock on brain perfusion in a swine model of raised intracranial pressure.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- Autoregulatory-guided management in traumatic brain injury: does age matter?Acta neurochirurgica · 2025Observational
- Albumin in Normovolemic Fluid Management for Severe Traumatic Brain Injury: Controversies and Research Gaps.Journal of clinical medicine · 2024Article
- Brain tissue oxygen monitoring in traumatic brain injury: part I-To what extent does PbtOCritical care (London, England) · 2023Article
- Current state of high-fidelity multimodal monitoring in traumatic brain injury.Acta neurochirurgica · 2022Review
- Verticalization for Refractory Intracranial Hypertension: A Case Series.Neurocritical care · 2022Article
- Carbon Dioxide Reactivity of Brain Tissue Oxygenation after Pediatric Traumatic Brain Injury.Children (Basel, Switzerland) · 2022Article
- Modulation of lymphatic transport in the central nervous system.Theranostics · 2022Review
- Traumatic Brain Injury-A Review of Intravenous Fluid Therapy.Frontiers in veterinary science · 2021Review
- Fine Tuning of Traumatic Brain Injury Management in Neurointensive Care-Indicative Observations and Future Perspectives.Frontiers in neurology · 2021Review
- "Take a Number"-Precision Monitoring Directs Precision Therapy.Neurocritical care · 2020Article
- Intracranial pressure elevation alters CSF clearance pathways.Fluids and barriers of the CNS · 2020Article
- Escalate and De-Escalate Therapies for Intracranial Pressure Control in Traumatic Brain Injury.Frontiers in neurology · 2020Review
- Nonoperative management of splenic injury in closely monitored patients with reduced consciousness is safe and feasible.Scandinavian journal of trauma, resuscitation and emergency medicine · 2019Article
- Resuscitation Strategies for Traumatic Brain Injury.Current surgery reports · 2019Article
- Vasopressor Therapy and the Brain: Dark Side of the Moon.Frontiers in medicine · 2019Review
- Fluid management concepts for severe neurological illness: an overview.Current opinion in anaesthesiology · 2018Review
Corrections and comments
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Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
When introduced in 1992, the Lund concept (LC) was the first complete guideline for treatment of severe traumatic brain injury (s-TBI). It was a theoretical approach, based mainly on general physiological principles-i.e., of brain volume control and optimization of brain perfusion and oxygenation of the penumbra zone. The concept gave relatively strict outlines for cerebral perfusion pressure, fluid therapy, ventilation, sedation, nutrition, the use of vasopressors, and osmotherapy. The LC strives for treatment of the pathophysiological mechanisms behind symptoms rather than just treating the symptoms. The treatment is standardized, with less need for individualization. Alternative guidelines published a few years later (e.g., the Brain Trauma Foundation guidelines and European guidelines) were mainly based on meta-analytic approaches from clinical outcome studies and to some extent from systematic reviews. When introduced, they differed extensively from the LC. We still lack any large randomized outcome study comparing the whole concept of BTF guidelines with other guidelines including the LC. From that point of view, there is limited clinical evidence favoring any of the s-TBI guidelines used today. In principle, the LC has not been changed since its introduction. Some components of the alternative guidelines have approached those in the LC. In this review, I discuss some important principles of brain hemodynamics that have been lodestars during formulation of the LC. Aspects of ventilation, nutrition, and temperature control are also discussed. I critically evaluate the most important components of the LC 25 years after its introduction, based on hemodynamic principles and on the results of own an others experimental and human studies that have been published since then.
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