Resuscitation Strategies for Traumatic Brain Injury
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Purpose of Review
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality; however, little definitive evidence exists about most clinical management strategies. Here, we highlight important differences between two major guidelines, the 2016 Brain Trauma Foundation guidelines and the Lund Concept, along with recent preclinical and clinical data.
While intracranial pressure (ICP) monitoring has been questioned, the majority of literature demonstrates benefit in severe TBI. The optimal cerebral perfusion pressure and ICP are yet unknown, but likely as important is the concept of ICP burden. The evidence for antihypertensive therapy is strengthening. Decompressive craniectomy improves mortality, but at the cost of increased morbidity. Plasma-based resuscitation has demonstrated benefit in multiple preclinical TBI studies.
The management of hemodynamics and intravascular volume are crucial in TBI. Based on recent evidence, ICP monitoring, antihypertensive therapy, minimal use of vasopressors/inotropes, and plasma resuscitation may improve outcomes.
KeywordsTraumatic brain injury Secondary brain injury Intracranial pressure Intracranial hypertension Cerebral perfusion pressure Lund concept
Conception, design, drafting of manuscript: HWC and CSC. Critical revision of the manuscript for important intellectual content: HWC and CSC. Manuscript supervision: HWC and CSC.
Compliance with Ethics Guidelines
Conflict of interest
Henry W. Caplan declares no potential conflicts of interest. Charles S. Cox Jr holds equity and royalty interests in Cellvation Inc. as well as a sponsored research agreement and scientific advisory board position. Dr. Cox Jr has sponsored research and holds a scientific advisory board position for CBR, Inc. He also sponsored research for Hope Bio, Inc., as well as Sponsored research and received equity/royalty interest from Coagulex, Inc.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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