Comprehensive Study And Prognostic Criteria Of The Main Systemic Mechanisms Of Secondary Brain Damage In Combined Craniocerebral Injury During The Acute Period

Abstract

Background: Secondary systemic mechanisms of brain damage significantly influence outcomes in patients with severe combined craniocerebral injury (SCTBI). Despite progress in neurocritical care, mortality remains high due to impaired cerebral perfusion regulation and systemic homeostatic disturbances.

Objective: This study aimed to investigate the main systemic mechanisms contributing to secondary brain injury in SCTBI and identify prognostic factors associated with poor outcomes.

Methods: A total of 270 patients with severe SCTBI treated from 2022 to 2024 were analyzed. Clinical, neurological, and laboratory parameters—including hemodynamics, oxygenation, and sodium balance—were evaluated. The relationships between arterial hypotension, hypoxemia, sodium and osmotic disturbances, and clinical outcomes were statistically assessed.

Results: Early arterial hypotension occurred in 81% of cases and was a strong independent predictor of mortality and vegetative outcomes. Combined arterial hypotension and hypoxemia significantly worsened prognosis, particularly in diffuse and compressive brain injuries. Sodium imbalance, including both hyponatremia (<125 mmol/L) and hypernatremia (>155 mmol/L), increased mortality by 36–64%. Lymphotropic antibiotic therapy demonstrated beneficial effects by improving perfusion and reducing cerebral edema.

Conclusion: Secondary systemic factors such as arterial hypotension, hypoxemia, and sodium imbalance play a decisive role in the pathogenesis of secondary ischemic brain injury. Early detection and correction of these factors are essential to improve survival and neurological recovery in patients with severe combined traumatic brain injury.