Search
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