Brain Injury and Dysfunction: The Critical Role of Primary Management
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In traumatic brain injury, maintain mean arterial (MAP) blood pressure >80 mmHg.
Avoid hypoxia at all costs; keep PaO2 >13 kPa, using PEEP if necessary.
Keep PaCO2 4.5–5.0 kPa; hyperventilate only if there are signs of impending brainstem herniation.
Keep the neck in neutral position; always consider the possibility of cervical spine injury.
Maintain 15°head up position (as long as MAP adequate).
Do not give mannitol if patient is hypotensive. Speak to a Regional Neurosurgical Center before giving additional doses.
KeywordsTraumatic Brain Injury Brain Edema Decompressive Craniectomy Cerebral Oxygen Regional Unit
- Modernisation Agency/Department of Health (2004) The Neurosciences Critical Care Report. London www.dh.gov.uk/publications
- NICE (2007) Head Injury: Triage, assessment, investigations and early management of head injury in infants, children and adults. London http://www.nice.org.uk/nicemedia/pdf/CG56NICEGuideline.pdf
- 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 www.nasgbi.org.uk