Brain Injury and Dysfunction: The Critical Role of Primary Management

  • M. D. Dominic Bell
Part of the Competency-Based Critical Care book series (CBCC)

Key Points

  1. 1.

    In traumatic brain injury, maintain mean arterial (MAP) blood pressure >80 mmHg.

  2. 2.

    Avoid hypoxia at all costs; keep PaO2 >13 kPa, using PEEP if necessary.

  3. 3.

    Keep PaCO2 4.5–5.0 kPa; hyperventilate only if there are signs of impending brainstem herniation.

  4. 4.

    Keep the neck in neutral position; always consider the possibility of cervical spine injury.

  5. 5.

    Maintain 15°head up position (as long as MAP adequate).

  6. 6.

    Do not give mannitol if patient is hypotensive. Speak to a Regional Neurosurgical Center before giving additional doses.



Traumatic Brain Injury Brain Edema Decompressive Craniectomy Cerebral Oxygen Regional Unit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Further Reading

  1. Clayton TJ, Nelson RJ, Manara AR (2004) Reduction in mortality from severe head injury following introduction of a protocol for intensive care management. Br J Anaesth 93(6):761–762CrossRefPubMedGoogle Scholar
  2. Modernisation Agency/Department of Health (2004) The Neurosciences Critical Care Report. London
  3. NICE (2007) Head Injury: Triage, assessment, investigations and early management of head injury in infants, children and adults. London
  4. The Neuro Anaesthesia Society of Great Britain and Ireland and The Association of Anaesthetists of Great Britain and Ireland (2006) Recommendations for the Safe Transfer of Patients with Brain Injury. London

Copyright information

© Springer-Verlag London Limited 2010

Authors and Affiliations

  • M. D. Dominic Bell
    • 1
  1. 1.Leeds General Infirmary Leeds Teaching Hospitals NHS TrustLeedsUK

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