[Management of closed head injury].
OBJECTIVE
To review current concepts regarding the management of severe closed head injury and determine the possible causes of brain damage in these patients.


METHODS
Severe closed head injury causes a high rate of mortality and disability in developed countries. The diagnosis and management of these patients has progressed in recent years, from the availability of brain scanning to varied therapeutic methods based on brain metabolism and intracranial dynamics. We have reviewed the different neuropathological processes in relation to closed head injury and emphasized the importance of recognition and control of the secondary lesions, which may have disastrous consequences for the patient. After clinical evaluation and early cardiorespiratory stabilization, the patients are taken to a critical care unit for continuous monitoring of the intracranial pressure, cerebral perfusion pressure and cerebral extraction of oxygen. We have discussed several therapeutic interventions taking into account the values obtained by continuous monitoring of these patients. As well as traditional measures (hyperventilation, manitol and barbiturate coma), there are other possibilities for treatment of these patients such as hypothermia, hypertonic saline solutions and neuroprotector agents.


CONCLUSIONS
All patients with closed head injuries should be evaluated and treated as emergencies, and admitted to a critical care unit to avoid secondary lesions such as hypoxemia, arterial hypotension and cerebral edema. Treatment should be aimed at maintenance of the intracranial pressure and cerebral perfusion within normal limits and also maintenance satisfactory jugular saturation.
Suárez
J I
JI
University Hospitals of Cleveland/Hanna 5, 11100 Euclid Avenue, Cleveland, OH 44106, USA. jis4@po.cwru.edu
D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D001463:Barbiturates / Q000627:therapeutic use; D001921:Brain / Q000378:metabolism; D001925:Brain Damage, Chronic / Q000517:prevention & control; D001929:Brain Edema / Q000517:prevention & control; D001930:Brain Injuries / Q000209:etiology / Q000628:therapy; D019090:Case Management; D002543:Cerebral Hemorrhage / Q000209:etiology; D002560:Cerebrovascular Circulation; D003131:Combined Modality Therapy; D003422:Critical Care; D003952:Diagnostic Imaging; D005440:Fluid Therapy; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007022:Hypotension / Q000517:prevention & control; D000860:Hypoxia / Q000517:prevention & control; D015994:Incidence; D007427:Intracranial Pressure; D008353:Mannitol / Q000627:therapeutic use; D008875:Middle Aged; D008991:Monitoring, Physiologic; D018696:Neuroprotective Agents / Q000627:therapeutic use; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D000927:Anticonvulsants; D001463:Barbiturates; D018696:Neuroprotective Agents; D008353:Mannitol