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Management of Acute Traumatic Brain Injury

  • Sungho Lee
  • Aditya Vedantam
  • Claudia S. RobertsonEmail author
  • Shankar Gopinath
Chapter
  • 55 Downloads
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

Traumatic brain injury (TBI) is a major cause of morbidity and mortality. Acute TBI management is focused on the prevention of secondary injury. Basic principles of critical care such as blood pressure management, mechanical ventilation, sedation, enteral nutrition, and sepsis treatment need to be uniquely tailored to the needs of the TBI patient. Intracranial hypertension is best approached with tiered escalation of care. While the Brain Trauma Foundation (BTF) has provided evidence-based guidelines for TBI management, the strength of recommendations is limited by lack of high-quality studies. Therefore, it is also useful to take into account the best practice guidelines put forth by the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP). Combining recommendations from the BTF and ACS TQIP, as well as clinical judgment, yields a practical and systematic approach to the individual TBI patient.

Keywords

Traumatic brain injury Neurocritical care Intracranial pressure Mechanical ventilation Enteral nutrition Tracheostomy Chemoprophylaxis 

References

  1. 1.
    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):844–54.CrossRefGoogle Scholar
  2. 2.
    Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(3 Suppl):S16–24; discussion Si–iv.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of acute epidural hematomas. Neurosurgery. 2006;58(3 Suppl):S7–15; discussion Si–iv.Google Scholar
  4. 4.
    Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of traumatic parenchymal lesions. Neurosurgery. 2006;58(3 Suppl):S25–46; discussion Si–iv.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GWJ, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury, Fourth Edition. Neurosurgery. 2017;80(1):6–15.CrossRefGoogle Scholar
  6. 6.
    Berry C, Ley EJ, Bukur M, Malinoski D, Margulies DR, Mirocha J, et al. Redefining hypotension in traumatic brain injury. Injury. 2012;43(11):1833–7.CrossRefGoogle Scholar
  7. 7.
    Yundt KD, Diringer MN. The use of hyperventilation and its impact on cerebral ischemia in the treatment of traumatic brain injury. Crit Care Clin. 1997;13(1):163–84.CrossRefGoogle Scholar
  8. 8.
    Mascia L. Acute lung injury in patients with severe brain injury: a double hit model. Neurocrit Care. 2009;11(3):417–26.CrossRefGoogle Scholar
  9. 9.
    Roberts DJ, Hall RI, Kramer AH, Robertson HL, Gallagher CN, Zygun DA. Sedation for critically ill adults with severe traumatic brain injury: a systematic review of randomized controlled trials∗. Crit Care Med. 2011;39(12):2743–51.CrossRefGoogle Scholar
  10. 10.
    Frey LC. Epidemiology of posttraumatic epilepsy: a critical review. Epilepsia. 2003;44(s10):11–7.CrossRefGoogle Scholar
  11. 11.
    Ronne-Engstrom E, Winkler T. Continuous EEG monitoring in patients with traumatic brain injury reveals a high incidence of epileptiform activity. Acta Neurol Scand. 2006;114(1):47–53.CrossRefGoogle Scholar
  12. 12.
    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.CrossRefGoogle Scholar
  13. 13.
    Claassen J, Taccone FS, Horn P, Holtkamp M, Stocchetti N, Oddo M. Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med. 2013;39(8):1337–51.CrossRefGoogle Scholar
  14. 14.
    Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012;367(26):2471–81.CrossRefGoogle Scholar
  15. 15.
    Contant CF, Valadka AB, Gopinath SP, Hannay HJ, Robertson CS. Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury. J Neurosurg. 2001;95(4):560–8.CrossRefGoogle Scholar
  16. 16.
    ACS TQIP Best Practice Guidelines [Internet]. American College of Surgeons. [cited 2018 Jun 25]. Available from: https://www.facs.org/quality-programs/trauma/tqip/best-practice.
  17. 17.
    Feldman Z, Kanter MJ, Robertson CS, Contant CF, Hayes C, Sheinberg MA, et al. Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients. J Neurosurg. 1992;76(2):207–11.CrossRefGoogle Scholar
  18. 18.
    Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D’urso P, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364(16):1493–502.CrossRefGoogle Scholar
  19. 19.
    Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016;375(12):1119–30.CrossRefGoogle Scholar
  20. 20.
    Cormio M, Gopinath SP, Valadka A, Robertson CS. Cerebral hemodynamic effects of pentobarbital coma in head-injured patients. J Neurotrauma. 1999;16(10):927–36.CrossRefGoogle Scholar
  21. 21.
    Greer DM, Funk SE, Reaven NL, Ouzounelli M, Uman GC. Impact of fever on outcome in patients with stroke and neurologic injury: a comprehensive meta-analysis. Stroke. 2008;39(11):3029–35.CrossRefGoogle Scholar
  22. 22.
    Puccio AM, Fischer MR, Jankowitz BT, Yonas H, Darby JM, Okonkwo DO. Induced normothermia attenuates intracranial hypertension and reduces fever burden after severe traumatic brain injury. Neurocrit Care. 2009;11(1):82–7.CrossRefGoogle Scholar
  23. 23.
    Coplin WM, Pierson DJ, Cooley KD, Newell DW, Rubenfeld GD. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000;161(5):1530–6.CrossRefGoogle Scholar
  24. 24.
    Andrews PJD, Sinclair HL, Rodriguez A, Harris BA, Battison CG, Rhodes JKJ, et al. Hypothermia for intracranial hypertension after traumatic brain injury. N Engl J Med. 2015;373(25):2403–12.CrossRefGoogle Scholar
  25. 25.
    Oddo M, Schmidt JM, Mayer SA, Chioléro RL. Glucose control after severe brain injury. Curr Opin Clin Nutr Metab Care. 2008;11(2):134–9.CrossRefGoogle Scholar
  26. 26.
    Kwiatt ME, Patel MS, Ross SE, Lachant MT, MacNew HG, Ochsner MG, et al. Is low-molecular-weight heparin safe for venous thromboembolism prophylaxis in patients with traumatic brain injury? A Western Trauma Association multicenter study. J Trauma Acute Care Surg. 2012;73(3):625–8.CrossRefGoogle Scholar
  27. 27.
    Kaufman HH, Satterwhite T, McConnell BJ, Costin B, Borit A, Gould L, et al. Deep vein thrombosis and pulmonary embolism in head injured patients. Angiology. 1983;34(10):627–38.CrossRefGoogle Scholar
  28. 28.
    Denson K, Morgan D, Cunningham R, Nigliazzo A, Brackett D, Lane M, et al. Incidence of venous thromboembolism in patients with traumatic brain injury. Am J Surg. 2007;193(3):380–3.. –384CrossRefGoogle Scholar
  29. 29.
    Dudley RR, Aziz I, Bonnici A, Saluja RS, Lamoureux J, Kalmovitch B, et al. Early venous thromboembolic event prophylaxis in traumatic brain injury with low-molecular-weight heparin: risks and benefits. J Neurotrauma. 2010;27(12):2165–72.CrossRefGoogle Scholar
  30. 30.
    Alali AS, Scales DC, Fowler RA, Mainprize TG, Ray JG, Kiss A, et al. Tracheostomy timing in traumatic brain injury: a propensity-matched cohort study. J Trauma Acute Care Surg. 2014;76(1):70–76-78.CrossRefGoogle Scholar
  31. 31.
    Bouderka MA, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A. Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma. 2004;57(2):251–4.CrossRefGoogle Scholar
  32. 32.
    Bell BA, Smith MA, Kean DM, McGhee CN, MacDonald HL, Miller JD, et al. Brain water measured by magnetic resonance imaging. Correlation with direct estimation and changes after mannitol and dexamethasone. Lancet Lond Engl. 1987;1(8524):66–9.CrossRefGoogle Scholar
  33. 33.
    Burke AM, Quest DO, Chien S, Cerri C. The effects of mannitol on blood viscosity. J Neurosurg. 1981;55(4):550–3.CrossRefGoogle Scholar
  34. 34.
    Dorman HR, Sondheimer JH, Cadnapaphornchai P. Mannitol-induced acute renal failure. Medicine (Baltimore). 1990;69(3):153–9.CrossRefGoogle Scholar
  35. 35.
    Torre-Healy A, Marko NF, Weil RJ. Hyperosmolar therapy for intracranial hypertension. Neurocrit Care. 2012;17(1):117–30.CrossRefGoogle Scholar
  36. 36.
    Aiyagari V, Deibert E, Diringer MN. Hypernatremia in the neurologic intensive care unit: how high is too high? J Crit Care. 2006;21(2):163–72.CrossRefGoogle Scholar
  37. 37.
    Roberts I, Sydenham E. Barbiturates for acute traumatic brain injury. Cochrane Database Syst Rev. 2012;(12):CD000033.Google Scholar
  38. 38.
    Crane PD, Braun LD, Cornford EM, Cremer JE, Glass JM, Oldendorf WH. Dose dependent reduction of glucose utilization by pentobarbital in rat brain. Stroke. 1978;9(1):12–8.CrossRefGoogle Scholar
  39. 39.
    Kawaguchi M, Furuya H, Patel PM. Neuroprotective effects of anesthetic agents. J Anesth. 2005;19(2):150–6.CrossRefGoogle Scholar
  40. 40.
    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.CrossRefGoogle Scholar
  41. 41.
    Nordby HK, Nesbakken R. The effect of high dose barbiturate decompression after severe head injury. A controlled clinical trial. Acta Neurochir. 1984;72(3–4):157–66.CrossRefGoogle Scholar
  42. 42.
    Ward JD, Becker DP, Miller JD, Choi SC, Marmarou A, Wood C, et al. Failure of prophylactic barbiturate coma in the treatment of severe head injury. J Neurosurg. 1985 Mar;62(3):383–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Sungho Lee
    • 1
  • Aditya Vedantam
    • 1
  • Claudia S. Robertson
    • 1
    Email author
  • Shankar Gopinath
    • 1
  1. 1.Department of NeurosurgeryBaylor College of MedicineHoustonUSA

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