Semin Neurol 2016; 36(06): 570-576
DOI: 10.1055/s-0036-1592169
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Critical Care Management of the Patient with Traumatic Brain Injury

G. Duemani Reddy
1   Department of Neurosurgery, Baylor College of Medicine, Ben Taub Hospital, Houston, Texas
,
Shankar Gopinath
1   Department of Neurosurgery, Baylor College of Medicine, Ben Taub Hospital, Houston, Texas
,
Claudia Robertson
1   Department of Neurosurgery, Baylor College of Medicine, Ben Taub Hospital, Houston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
01 December 2016 (online)

Abstract

The critical care management of patients with traumatic brain injury is complex. The primary goal is to minimize the effects of secondary injury that would otherwise serve to further worsen neurologic function. This requires an understanding of the abnormal brain physiology that is found in these patients. In this article the authors discuss this physiology and describe suggested treatment strategies for these patients based on evidence-based guidelines.

 
  • References

  • 1 Waxweiler RJ, Thurman D, Sniezek J, Sosin D, O'Neil J. Monitoring the impact of traumatic brain injury: a review and update. J Neurotrauma 1995; 12 (4) 509-516
  • 2 Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. J Neurotrauma 2007; 24 (Suppl. 01) S1-S106
  • 3 Le Roux P, Menon DK, Citerio G , et al. Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Neurocrit Care 2014; 21 (Suppl. 02) S1-S26
  • 4 American College of Surgeons. ACS TQIP Best Practices in the Management of Traumatic Brain Injury. Available at: https://www.facs.org/∼/media/files/quality%20programs/trauma/tqip/traumatic%20brain%20injury%20guidelines.ashx . Accessed February 10, 2016
  • 5 Cnossen MC, Scholten AC, Lingsma H , et al. Adherence to guidelines in adult patients with traumatic brain injury: a living systematic review. J Neurotrauma 2015; DOI: doi:10.1089/neu.2015.4121.
  • 6 Griesdale DEG, Örtenwall V, Norena M , et al. Adherence to guidelines for management of cerebral perfusion pressure and outcome in patients who have severe traumatic brain injury. J Crit Care 2015; 30 (1) 111-115
  • 7 Chesnut RM, Marshall LF, Klauber MR , et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993; 34 (2) 216-222
  • 8 Van Aken HK, Kampmeier TG, Ertmer C, Westphal M. Fluid resuscitation in patients with traumatic brain injury: what is a SAFE approach?. Curr Opin Anaesthesiol 2012; 25 (5) 563-565
  • 9 Strandvik GF. Hypertonic saline in critical care: a review of the literature and guidelines for use in hypotensive states and raised intracranial pressure. Anaesthesia 2009; 64 (9) 990-1003
  • 10 Steiner LA, Johnston AJ, Czosnyka M , et al. Direct comparison of cerebrovascular effects of norepinephrine and dopamine in head-injured patients. Crit Care Med 2004; 32 (4) 1049-1054
  • 11 Sookplung P, Siriussawakul A, Malakouti A , et al. Vasopressor use and effect on blood pressure after severe adult traumatic brain injury. Neurocrit Care 2011; 15 (1) 46-54
  • 12 Robertson CS, Clifton GL, Taylor AA, Grossman RG. Treatment of hypertension associated with head injury. J Neurosurg 1983; 59 (3) 455-460
  • 13 Jones PA, Andrews PJ, Midgley S , et al. Measuring the burden of secondary insults in head-injured patients during intensive care. J Neurosurg Anesthesiol 1994; 6 (1) 4-14
  • 14 Goodpasture HC, Romig DA, Voth DW, Liu C, Brackett CE. A prospective study of tracheobronchial bacterial flora in acutely brain-injured patients with and without antibiotic prophylaxis. J Neurosurg 1977; 47 (2) 228-235
  • 15 Kevric J, Jelinek GA, Knott J, Weiland TJ. Validation of the Full Outline of Unresponsiveness (FOUR) Scale for conscious state in the emergency department: comparison against the Glasgow Coma Scale. Emerg Med J 2011; 28 (6) 486-490
  • 16 Bruno M-A, Ledoux D, Lambermont B , et al. Comparison of the Full Outline of UnResponsiveness and Glasgow Liege Scale/Glasgow Coma Scale in an intensive care unit population. Neurocrit Care 2011; 15 (3) 447-453
  • 17 Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol 2014; 13 (8) 844-854
  • 18 Stocchetti N, Maas AIR, Chieregato A, van der Plas AA. Hyperventilation in head injury: a review. Chest 2005; 127 (5) 1812-1827
  • 19 Diringer MN. Hyperoxia: good or bad for the injured brain?. Curr Opin Crit Care 2008; 14 (2) 167-171
  • 20 Kumaria A, Tolias CM. Normobaric hyperoxia therapy for traumatic brain injury and stroke: a review. Br J Neurosurg 2009; 23 (6) 576-584
  • 21 Alali AS, Scales DC, Fowler RA , et al. Tracheostomy timing in traumatic brain injury: a propensity-matched cohort study. J Trauma Acute Care Surg 2014; 76 (1) 70-76 , discussion 76–78
  • 22 Cook AM, Peppard A, Magnuson B. Nutrition considerations in traumatic brain injury. Nutr Clin Pract 2008; 23 (6) 608-620
  • 23 Phelan HA. Pharmacologic venous thromboembolism prophylaxis after traumatic brain injury: a critical literature review. J Neurotrauma 2012; 29 (10) 1821-1828
  • 24 Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med 1994; 331 (24) 1601-1606
  • 25 Sachdeva A, Dalton M, Amaragiri SV, Lees T. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev 2014; 12 (12) CD001484
  • 26 Agnelli G, Piovella F, Buoncristiani P , et al. Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med 1998; 339 (2) 80-85
  • 27 Alhazzani W, Alenezi F, Jaeschke RZ, Moayyedi P, Cook DJ. Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2013; 41 (3) 693-705
  • 28 Fletcher JJ, Bergman K, Blostein PA, Kramer AH. Fluid balance, complications, and brain tissue oxygen tension monitoring following severe traumatic brain injury. Neurocrit Care 2010; 13 (1) 47-56
  • 29 Kramer AH, Roberts DJ, Zygun DA. Optimal glycemic control in neurocritical care patients: a systematic review and meta-analysis. Crit Care 2012; 16 (5) R203
  • 30 Godoy DA, Di Napoli M, Rabinstein AA. Treating hyperglycemia in neurocritical patients: benefits and perils. Neurocrit Care 2010; 13 (3) 425-438
  • 31 Lippi G, Cervellin G. Disseminated intravascular coagulation in trauma injuries. Semin Thromb Hemost 2010; 36 (4) 378-387
  • 32 Robertson CS, Hannay HJ, Yamal J-M , et al; Epo Severe TBI Trial Investigators. Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial. JAMA 2014; 312 (1) 36-47
  • 33 Chesnut RM, Temkin N, Carney N , et al; Global Neurotrauma Research Group. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 2012; 367 (26) 2471-2481
  • 34 Zabramski JM, Whiting D, Darouiche RO , et al. Efficacy of antimicrobial-impregnated external ventricular drain catheters: a prospective, randomized, controlled trial. J Neurosurg 2003; 98 (4) 725-730
  • 35 Czosnyka M, Pickard JD. Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry 2004; 75 (6) 813-821
  • 36 Cruz J, Minoja G, Okuchi K, Facco E. Successful use of the new high-dose mannitol treatment in patients with Glasgow Coma Scale scores of 3 and bilateral abnormal pupillary widening: a randomized trial. J Neurosurg 2004; 100 (3) 376-383
  • 37 Vialet R, Albanèse J, Thomachot L , et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med 2003; 31 (6) 1683-1687
  • 38 Eisenberg HM, Frankowski RF, Contant CF, Marshall LF, Walker MD. High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg 1988; 69 (1) 15-23
  • 39 Cooper DJ, Rosenfeld JV, Murray L , et al; DECRA Trial Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011; 364 (16) 1493-1502
  • 40 Sahuquillo J, Martínez-Ricarte F, Poca M-A. Decompressive craniectomy in traumatic brain injury after the DECRA trial. Where do we stand?. Curr Opin Crit Care 2013; 19 (2) 101-106
  • 41 Skoglund TS, Eriksson-Ritzén C, Jensen C, Rydenhag B. Aspects on decompressive craniectomy in patients with traumatic head injuries. J Neurotrauma 2006; 23 (10) 1502-1509
  • 42 Sedney CL, Julien T, Manon J, Wilson A. The effect of craniectomy size on mortality, outcome, and complications after decompressive craniectomy at a rural trauma center. J Neurosci Rural Pract 2014; 5 (3) 212-217
  • 43 Thompson HJ, Tkacs NC, Saatman KE, Raghupathi R, McIntosh TK. Hyperthermia following traumatic brain injury: a critical evaluation. Neurobiol Dis 2003; 12 (3) 163-173
  • 44 Andrews PJD, Sinclair HL, Rodriguez A , et al; Eurotherm3235 Trial Collaborators. Hypothermia for intracranial hypertension after traumatic brain injury. N Engl J Med 2015; 373 (25) 2403-2412
  • 45 Edwards P, Arango M, Balica L , et al; CRASH trial collaborators. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Lancet 2005; 365 (9475) 1957-1959
  • 46 Bratton SL, Chestnut RM, Ghajar J , et al; Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfusion thresholds. J Neurotrauma 2007; 24 (Suppl. 01) S59-S64
  • 47 Temkin NR, Dikmen SS, Wilensky AJ, Keihm J, Chabal S, Winn HR. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med 1990; 323 (8) 497-502
  • 48 Cotton BA, Kao LS, Kozar R, Holcomb JB. Cost-utility analysis of levetiracetam and phenytoin for posttraumatic seizure prophylaxis. J Trauma 2011; 71 (2) 375-379