Treatment of intracranial hypertension.
OBJECTIVE
The review provides key points and recent advances regarding the treatments of intracranial hypertension as a consequence of traumatic brain injury. The review is based on the pathophysiology of brain edema and draws on the current literature as well as clinical bedside experience.


RESULTS
The review will cite baseline literature and discuss emerging data on cerebral perfusion pressure, sedation, hypothermia, osmotherapy and albumin as treatments of intracranial hypertension in traumatic brain-injured patients.


CONCLUSIONS
One of the key issues is to consider that traumatic brain injury is more likely a syndrome than a disease. In particular, the presence or absence of a high contusional volume could influence the treatments to be implemented. The use of osmotherapy and/or high cerebral perfusion pressure should be restricted to patients without major contusions. Some physiopathological, experimental and clinical data, however, show that corticosteroids and albumin--therapies that have been proven deleterious if administered systematically--are worth reconsidering for this subgroup of patients. The current Pitié-Salpêtrière algorithm, where treatments are stratified according to their potential side effects, will be added at the end of the review as an example of an integrated strategy.
Lescot
Thomas
T
Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie-Paris 6, Paris, France.
Abdennour
Lamine
L
Boch
Anne-Laure
AL
Puybasset
Louis
L
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000418:Albumins / Q000627:therapeutic use; D000758:Anesthesia; D001930:Brain Injuries / Q000150:complications*; D006801:Humans; D007035:Hypothermia; D019586:Intracranial Hypertension / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*
D000305:Adrenal Cortex Hormones; D000418:Albumins