Severe traumatic brain injury: maximizing outcomes.
Severe traumatic brain injury is one of the leading causes of death and disability in the United States. The initial management of traumatic brain injury involves early resuscitation, computed tomography scanning, and surgical evacuation of mass lesions, when indicated. Recent research suggests that the prevention and treatment of secondary brain injury decrease mortality and improve outcomes. Specifically, treatment should address not only cerebral protection but also prevention of injury to other organ systems. To achieve the best outcomes, attention must be focused on optimizing blood pressure and brain tissue oxygenation, maintaining adequate cerebral perfusion pressures, and preventing seizures. In addition, maximizing good outcomes depends on proactively addressing the risk of common sequelae of brain injury, including infection, deep venous thrombosis, and inadequate nutrition. Guidelines developed for the management of severe traumatic brain injury have dramatically improved functional neurological outcomes.
Tang
Mary E
ME
Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA.
Lobel
Darlene A
DA
D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D004232:Diuretics / Q000008:administration & dosage; D005665:Furosemide / Q000008:administration & dosage; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000517:prevention & control; D019586:Intracranial Hypertension / Q000209:etiology / Q000517:prevention & control; D019585:Intracranial Hypotension / Q000209:etiology / Q000517:prevention & control; D008353:Mannitol / Q000008:administration & dosage; D044623:Nutrition Therapy; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods; D012640:Seizures / Q000209:etiology / Q000517:prevention & control; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control
D004232:Diuretics; D006993:Hypnotics and Sedatives; D008353:Mannitol; D005665:Furosemide