Early hospital care of severe traumatic brain injury

Abstract

Summary Head injury is one of the major causes of trauma‐related morbidity and mortality in all age groups in the United Kingdom, and anaesthetists encounter this problem in many areas of their work. Despite a better understanding of the pathophysiological processes following traumatic brain injury and a wealth of research, there is currently no specific treatment. Outcome remains dependant on basic clinical care: management of the patient’s airway with particular attention to preventing hypoxia; avoidance of the extremes of lung ventilation; and the maintenance of adequate cerebral perfusion, in an attempt to avoid exacerbating any secondary injury. Hypertonic fluids show promise in the management of patients with raised intracranial pressure. Computed tomography scanning has had a major impact on the early identification of lesions amenable to surgery, and recent guidelines have rationalised its use in those with less severe injuries. Within critical care, the importance of controlling blood glucose is becoming clearer, along with the potential beneficial effects of hyperoxia. The major improvement in outcome reflects the use of protocols to guide resuscitation, investigation and treatment and the role of specialist neurosciences centres in caring for these patients. Finally, certain groups are now recognised as being at greater risk, in particular the elderly, anticoagulated patient. You can respond to this article at http://www.anaesthesiacorrespondence.com

Severe traumatic brain injury in Norway: Impact of age on outcome

“…The high number of elderly people receiving anti-coagulation and anti-thrombotic medications is worth noting. Although they did not influence the mortality or crude measurements of early outcome in the present study, these medications may contribute to minor falls that result in severe TBI, and interact with complications and treatment results (34). Anti-thrombotic medication may, in particular, contribute to the high frequency of SDH in elderly people, where prompt intervention and craniotomy are of particular importance (35).…”

“…It is worth noting that less aggressive monitoring and treatment may also cause higher mortality (11). The major improvement in outcome over the last years reflects the use of protocols to guide all phases of treatment for these patients, with focus on certain groups now recognized as being at greater risk, in particular elderly people, and anti-coagulated patients (34). Thus, the lack of national guidelines for hospital treatment of severe TBI in Norway adapted to elderly people is a major challenge.…”

Low‐Level Laser Therapy for Closed‐Head Traumatic Brain Injury in Mice: Effect of Different Wavelengths

“…This combination of cellular and physiologic disturbances causes increased neuronal cell death, enlargement of infarct size, and neurological, motor, and cognitive impairment. Since there are no approved specific pharmacological agents that block the progression of the secondary injury, the current management of TBI is mainly supportive and aims at treating brain edema, reducing ICP, and combating complications, such as hypoxia and shock 15. Despite promising preclinical data, most of the clinical trials that have been performed in recent years have failed to demonstrate any significant improvement in outcome 16.…”

Nursing management of adults with severe traumatic brain injury: A narrative review

“…[ 17 ] Hyperventilation therapy can reduce ICP,[ 11 ] but there is no strong evidence which indicates whether this improves outcomes. [ 19 ] Correction of hypotension[ 20 ] and hypoxia helps in improving patient outcomes. [ 16 ]…”