Acute Management of Traumatic Brain Injury

Abstract

Traumatic brain injury (TBI) is a leading cause of death and disability in patients with trauma. Management strategies must focus on preventing secondary injury by avoiding hypotension and hypoxia and maintaining appropriate cerebral perfusion pressure (CPP), which is a surrogate for cerebral blood flow. CPP can be maintained by increasing mean arterial pressure, decreasing intracranial pressure, or both. The goal should be euvolemia and avoidance of hypotension. Other factors that deserve important consideration in the acute management of patients with TBI are venous thromboembolism, stress ulcer, and seizure prophylaxis, as well as nutritional and metabolic optimization.

Keywords: Barbiturate coma; Decompressive craniectomy; Hyperosmolar therapy; Intracranial hypertension; Secondary injury; Traumatic brain injury.

Published by Elsevier Inc.

Figures

Figure 1

Algorithmic Approach to the Management of Severe Traumatic Brain Injury (GCS