Critical care management of head injury

Abstract

The intensive care management of head injury requires a coordinated, comprehensive and multidisciplinary approach to treatment. crucial to management is the prevention of secondary brain injury by avoidance of systemic physiological disturbances, such as hypotension and hypoxae mia, and maintenance of adequate cerebral perfusion and oxygenation. There have been marked improvements in the treatment of patients with severe traumatic brain injury over the last decade, leading to a reduction in both mortality and morbidity. advances in management in the pre hospital setting and in the a&e department have now been extended into the intensive care unit. The management of head injury has undergone extensive revision as evidence accumulates that established practices are not as effective or innocuous as previously believed. Management protocols have evolved with international consensus, providing guide lines that assist clinicians in delivering optimal care. improved diagnos tic and monitoring modalities are improving our understanding of the pathobiology of head injury and allowing the delivery of individualized therapeutic interventions.Keywords cerebral perfusion pressure; head injury; intracranial pressure; neurointensive care Traumatic brain injury (TBI) is a major cause of mortality and morbidity, particularly in young people. The overall incidence is around 450 per 100,000 for all head injuries and 40 per 100,000 for moderate and severe injury. TBI is more common in males than females and in those of lower socioeconomic status. It accounts for 1% of overall deaths and 15% of deaths in the 15-45-year age group. The causes are multifactorial and include road traffic accidents (40-50%), falls (18%) and assaults (10%).