title: [Intensive care treatment of traumatic brain injury in multiple trauma patients : Decision making for complex pathophysiology].
abstract: Traumatic brain injury (TBI) and hemorrhagic shock due to uncontrolled bleeding are the major causes of death after severe trauma. Mortality rates are threefold higher in patients suffering from multiple injuries and additionally TBI. Factors known to impair outcome after TBI, namely hypotension, hypoxia, hypercapnia, acidosis, coagulopathy and hypothermia are aggravated by the extent and severity of extracerebral injuries. The mainstays of TBI intensive care may be, at least temporarily, contradictory to the trauma care concept for multiple trauma patients. In particular, achieving normotension in uncontrolled bleeding situations, maintenance of normocapnia in traumatic lung injury and thromboembolic prophylaxis are prone to discussion. Due to an ongoing uncertainty about the definition of normotensive blood pressure values, a cerebral perfusion pressure-guided cardiovascular management is of key importance. In contrast, there is no doubt that early goal directed coagulation management improves outcome in patients with TBI and multiple trauma. The timing of subsequent surgical interventions must be based on the development of TBI pathology; therefore, intensive care of multiple trauma patients with TBI requires an ongoing and close cooperation between intensivists and trauma surgeons in order to individualize patient care.
authors.affiliation: Abteilung für Anästhesie, Notfall- und Allgemeine Intensivmedizin und Karl-Landsteiner Institut für Notfallmedizin, Landesklinikum Wiener Neustadt, Wien, Österreich.|ÖAMTC Flugrettung, Wien, Österreich.
authors.forename: H
authors.initials: H
authors.lastname: Trimmel
authors.affiliation: Abteilung für Anästhesie, Notfall- und Allgemeine Intensivmedizin und Karl-Landsteiner Institut für Notfallmedizin, Landesklinikum Wiener Neustadt, Wien, Österreich.
authors.forename: G
authors.initials: G
authors.lastname: Herzer
authors.affiliation: Institut für Anästhesiologie und Intensivmedizin, AUVA Unfallkrankenhaus Salzburg, Dr.-Franz-Rehrl-Platz 5, 5010, Salzburg, Österreich.|Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich.
authors.forename: H
authors.initials: H
authors.lastname: Schöchl
authors.affiliation: Institut für Anästhesiologie und Intensivmedizin, AUVA Unfallkrankenhaus Salzburg, Dr.-Franz-Rehrl-Platz 5, 5010, Salzburg, Österreich. wolfgang.voelckel@auva.at.|ÖAMTC Flugrettung, Wien, Österreich. wolfgang.voelckel@auva.at.|Universität Stavanger, Stavanger, Norwegen. wolfgang.voelckel@auva.at.|Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich. wolfgang.voelckel@auva.at.
authors.forename: W G
authors.initials: WG
authors.lastname: Voelckel
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000187:drug effects / Q000502:physiology; D001921:Brain / Q000098:blood supply; D000070642:Brain Injuries, Traumatic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002245:Carbon Dioxide / Q000097:blood; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D015897:Comorbidity; D003422:Critical Care / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation; D015600:Glasgow Coma Scale; D006801:Humans; D055370:Lung Injury / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008991:Monitoring, Physiologic / Q000379:methods; D009104:Multiple Trauma / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012121:Respiration, Artificial; D012771:Shock, Hemorrhagic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013923:Thromboembolism / Q000517:prevention & control; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014662:Vasoconstrictor Agents; D002245:Carbon Dioxide
keywords: Cerebral perfusion pressure; Decision making; Goal directed therapy; Multiple trauma; Pathophysiology