Guidelines for Management of Severe Head Injury in Adults

Abstract

Severe head injury is the leading cause of death and disability in young adults. It accounts for one quarter to one third of trauma deaths and for a much larger proportion of life long disability after trauma [1]. Neurotrauma constitutes a serious public health problem, requiring prevention and continuing improvement in the care of head injured patients. Currently, in major neurotrauma centers, the mortality rate of severely head injured patients (GCS≤8) is approximately 20 to 25%. The challenge to lower this mortality rate and especially to decrease the rate of disability remains unequivocally high. Clinical and laboratory research have greatly increased our understanding of the pathophysiology of head injury. One of the central concepts is that the primary brain damage, occurring at the moment of impact, initiates a process of secondary events, causing further damage, mainly due to cerebral ischemia. The importance of secondary delayed insults and of changes at the biochemical level is increasingly recognized. The concept of secondary brain damage has led to an interest in developing better monitoring methods, and our improved understanding of changes at the biochemical level has stimulated research into new pharmaceuticals with the potential of inhibiting pathophysiologic processes. Currently, drugs that inhibit lipid peroxidative damage and neurotransmittor-induced secondary damage are being investigated in large multinational randomized clinical trials. Many other drugs acting at various biochemical pathways are being developed and some show promising results in laboratory experiments.