Management of patients with severe traumatic brain injury

Abstract

Management of severe traumatic brain injury (TBI) is based on early resuscitation — aiming to avoid hypoxia and hypotension, the rapid patient transfer to specialised neuroscience centers with neurosurgical availability, early surgical evacuation of acute cerebral lesions and invasive monitoring of intracranial pressure in TBI patients with abnormal admission CT-scan (contusions, hemorrhage, hematoma). Upon intensive care unit admission, treatment will be focused on the prevention/attenuation of secondary brain injuries of intra-cerebral (intracranial hypertension, cerebral ischemia, non-convulsive seizures) and sytemic (hyperthermia, hyperglycemia) etiology, according to a standardised algorithm. The application of such standardised therapeutic strategy has been shown by several studies to improve TBI prognosis and overall care of head-injured patients.