UMEM Educational Pearls

Title: TBI - Critical Care

Keywords: traumatic brain injury, cerebral perfusion pressure, intracranial pressure, hypertonic saline (PubMed Search)

Posted: 10/30/2007 by Mike Winters, MBA, MD (Updated: 11/22/2024)
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Critical Care Pearls for Traumatic Brain Injury

Avoid hypotension and hypoxia - SBP < 90 and/or PaO2 < 60 are associated with significant increases in morbidity and mortality
Hypertonic saline remains controversial - a recent large, controlled trial did not show any early or long-term benefit
ICP monitoring routinely recommended in patients with GCS < 8 - they have a 60% chance of increased ICP
Maintain ICP < 20 mmHg and CPP > 60
Supportive care
- Elevate the head of bed > 30 degrees, if possible
- Control fever
- Provide analgesia and sedation
Ventilator management - keep PaCO2 between 30-35 mmHg
Surgery - last resort to controlling increased ICP
- Decompressive craniotomy
- Decompressive laparotomy