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Chapter 4 - Critical Care Management of Traumatic Brain Injury

Published online by Cambridge University Press:  10 August 2021

By
Ximena Watson  and
Michael Puntis
Edited by
Marco Mula
Marco Mula
Affiliation:
St George's Hospital Medical School, University of London
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Summary

Severe traumatic brain injury (TBI) includes a heterogenous set of injury patterns and affects a wide range of population groups including children, young adults and the elderly. It can cause death or disabling morbidity and is associated with significant socioeconomic burden.

Following the primary injury, a series of metabolic, inflammatory and vascular processes occur which may lead to secondary tissue damage. Additionally, patients with severe TBI are also at increased risk of systemic complications.

The initial resuscitation and subsequent critical care management of patients with TBI focuses on limiting secondary brain injury. This requires a systematic approach to avoid physiological disturbances which may worsen cerebral oxygen delivery and energy substrate metabolism. Factors such as hypotension, hypoxaemia, hypo- and hyperglycaemia and hyperthermia can directly exacerbate the secondary injury and lead to worse outcomes. The maintenance of cerebral perfusion with adequate cerebral oxygenation and energy substrate delivery is critical but may be challenging to achieve.

Management protocols have evolved with international consensus, providing guidelines that can assist clinicians in delivering optimal care.

Keywords

traumatic brain injuryneurocritical carecerebral perfusionintracranial pressuremultimodality neuromonitoring
Type
Chapter
Information
Post-traumatic Epilepsy , pp. 63 - 77
Publisher: Cambridge University Press
Print publication year: 2021

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References

Sundheim, SM, Cruz, M. The evidence for spinal immobilization: an estimate of the magnitude of the treatment benefit. Ann Emerg Med 2006;48:217–8; author reply 18–9.Google Scholar
CRASH_Trial_Collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet 2019; 394:1713–23.Google Scholar
Holzmacher, JL, Reynolds, C, Patel, M, et al. Platelet transfusion does not improve outcomes in patients with brain injury on antiplatelet therapy. Brain Inj 2018;32:325–30.Google Scholar
Dunn, MS, Beck, B, Simpson, PM, et al. Comparing the outcomes of isolated, serious traumatic brain injury in older adults managed at major trauma centres and neurosurgical services: A registry-based cohort study. Injury 2019;50:1534–9.Google Scholar
Faul, M, Coronado, V. Epidemiology of traumatic brain injury. Handb Clin Neurol 2015;127:3–13.Google Scholar
Zhang, W, Du, K, Chen, X. Benefits of red blood cell transfusion in patients with traumatic brain injury. Crit Care 2019;23:218.Google Scholar
Lelubre, C, Bouzat, P, Crippa, IA, et al. Anemia management after acute brain injury. Crit Care 2016;20:152.Google Scholar
Kramer, AH, Roberts, DJ, Zygun, DA. Optimal glycemic control in neurocritical care patients: a systematic review and meta-analysis. Crit Care 2012;16:R203.Google Scholar
Kleindienst, A, Brabant, G, Bock, C, et al. Neuroendocrine function following traumatic brain injury and subsequent intensive care treatment: a prospective longitudinal evaluation. J Neurotrauma 2009;26:1435–46.Google Scholar
Gerber, LM, Chiu, YL, Carney, N, et al. Marked reduction in mortality in patients with severe traumatic brain injury. J Neurosurg 2013;119(6):1583–90.Google Scholar
Chesnut, RM, Temkin, N, Carney, N, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 2012;367(26):2471–81.Google Scholar
Carney, N, Totten, AM, O’Reilly, C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery 2017;80(1):6–15.Google Scholar
Depreitere, B, Guiza, F, Van den Berghe, G, et al. Pressure autoregulation monitoring and cerebral perfusion pressure target recommendation in patients with severe traumatic brain injury based on minute-by-minute monitoring data. J Neurosurg 2014;120(6):1451–7.CrossRefGoogle ScholarPubMed
Cooper, DJ, Nichol, AD, Bailey, M, et al. Effect of early sustained prophylactic hypothermia on neurologic outcomes among patients with severe traumatic brain injury: The POLAR randomized clinical trial. JAMA 2018;320(21):2211–20.Google Scholar
Clifton, GL, Coffey, CS, Fourwinds, S, et al. Early induction of hypothermia for evacuated intracranial hematomas: a post hoc analysis of two clinical trials. J Neurosurg 2012;117(4):714–20.Google Scholar
Suehiro, E, Koizumi, H, Fujisawa, H, et al. Diverse effects of hypothermia therapy in patients with severe traumatic brain injury based on the computed tomography classification of the traumatic coma data bank. J Neurotrauma 2015;32(5):353–8.Google Scholar
Andrews, PJ, Sinclair, HL, Rodriguez, A, et al. Hypothermia for intracranial hypertension after traumatic brain injury. N Engl J Med 2015;373(25):2403–12.Google Scholar
Maekawa, T, Yamashita, S, Nagao, S, et al. Prolonged mild therapeutic hypothermia versus fever control with tight hemodynamic monitoring and slow rewarming in patients with severe traumatic brain injury: a randomized controlled trial. J Neurotrauma 2015;32(7):422–9.Google Scholar
Burgess, S, Abu-Laban, RB, Slavik, RS, et al. A systematic review of randomized controlled trials comparing hypertonic sodium solutions and mannitol for traumatic brain injury: implications for emergency department management. Ann Pharmacother 2016;50(4):291–300.Google Scholar
Honeybul, S, Ho, KM, Lind, CRP, et al. The current role of decompressive craniectomy for severe traumatic brain injury. J Clin Neurosci 2017;43:11–15.Google Scholar
Carteron, L, Bouzat, P, Oddo, M. Cerebral microdialysis monitoring to improve individualized neurointensive care therapy: An update of recent clinical data. Front Neurol 2017;8:601.Google Scholar

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