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Prise en charge du traumatisme crânien cérébral grave

Management of patients with severe traumatic brain injury

  • Enseignement Supérieur en Soins Infirmiers
  • Published:
Réanimation

Résumé

La prise en charge du traumatisme crânien cérébral (TCC) grave est fondée sur la réanimation précoce — dans le but d’éviter l’hypoxie et l’hypotension artérielle — et le transfert dans un centre spécialisé avec plateau neurochirurgical, afin de permettre la chirurgie d’évacuation urgente lors de lésions cérébrales aiguës et le monitorage invasif de la pression intracrânienne lors de TCC grave (score de Glasgow <9) avec tomodensitométrie cérébrale anormale (contusion, hémorragie, hématome). Après admission en réanimation, le traitement vise à prévenir/limiter les lésions cérébrales secondaires d’origine intracérébrale (hypertension intracrânienne, ischémie cérébrale, épilepsies non convulsivantes) et systémiques (hyperthermie, hyperglycémie) à l’aide d’un algorithme standardisé. L’application d’une telle stratégie thérapeutique standardisée s’est montrée efficace — dans plusieurs études — pour améliorer le pronostic et la prise en charge globale du patient TCC grave.

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.

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  1. Service de médecine intensive adulte, Centre Hospitalier Universitaire Vvaudois (CHUV), CH-1011, Lausanne, Suisse

    N. Ben Hamouda & M. Oddo

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  1. N. Ben Hamouda
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  2. M. Oddo
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Correspondence to M. Oddo.

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Cet article correspond à la conférence faite par l’auteur au congrès de la SRLF 2013 dans la session: Polytraumatisme.

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Ben Hamouda, N., Oddo, M. Prise en charge du traumatisme crânien cérébral grave. Réanimation 22 (Suppl 2), 479–487 (2013). https://doi.org/10.1007/s13546-012-0620-4

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  • DOI: https://doi.org/10.1007/s13546-012-0620-4

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