Traumatic brain injury: physiological targets for clinical practice in the prehospital setting and on the Neuro-ICU.
OBJECTIVE
Over many years, understanding of the pathophysiology in traumatic brain injury (TBI) has resulted in the development of core physiological targets and therapies to preserve cerebral oxygenation, and in doing so prevent secondary insult. The present review revisits the evidence for these targets and therapies.


RESULTS
Achieving oxygen, carbon dioxide, blood pressure, temperature and glucose targets remain a key goal of therapy in TBI, as does the role of effective prehospital care. Physician led air ambulance teams reduce mortality. Normobaric hyperoxia is dangerous to the injured brain; as are both high and low carbon dioxide levels. Hypotension is life threatening and higher targets have now been suggested in TBI. Both therapeutic normothermia and hypothermia have a role in specific groups of patients with TBI. Although consensus has not been reached on the optimal intravenous fluid for resuscitation in TBI, vigilant goal-directed fluid administration may improve outcome. Osmotherapeutic agents such as hypertonic sodium lactate solutions may also have a role alongside conventional agents.


CONCLUSIONS
Maintaining physiological targets in several areas remains part of protocol led care in the acute phase of TBI management. As evidence accumulates however, the target values and therefore therapies may be set to change.
aConsultant Intensivist, Department of Neuro Intensive Care, Queens Hospital, BHR NHS Trust, Romford bHonorary Senior Clinical Lecturer, Queen Mary's University of London cSpecialist Registrar Anesthesiology, Queens Hospital dSpecialist Registrar Intensive Care Medicine, Royal London Hospital, UK.
Dhuleep S
DS
Wijayatilake
Suyogi V
SV
Jigajinni
Peter B
PB
Sherren
D015415:Biomarkers; D001930:Brain Injuries / Q000503:physiopathology / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007427:Intracranial Pressure
D015415:Biomarkers