UMEM Educational Pearls

Category: Critical Care

Title: TBI - Critical Care

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

Posted: 10/30/2007 by Mike Winters, MD (Updated: 2/24/2020)
Click here to contact Mike Winters, MD

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