Management of traumatic brain injury in the non‐neurosurgical intensive care unit: a narrative review of current evidence

Abstract

Each year, approximately 70 million people suffer traumatic brain injury, which has a significant physical, psychosocial and economic impact for patients and their families. It is recommended in the UK that all patients with traumatic brain injury and a Glasgow coma scale ≤ 8 should be transferred to a neurosurgical centre. However, many patients, especially those in whom neurosurgery is not required, are not treated in, nor transferred to, a neurosurgical centre. This review aims to provide clinicians who work in non-neurosurgical centres with a summary of contemporary studies relevant to the critical care management of patients with traumatic brain injury. A targeted literature review was undertaken that included guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials (published in English between 1 January 2017 and 1 July 2022). Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also eligible for inclusion. Analysis of the topics identified during the review was then summarised. These included: fundamental critical care management approaches (including ventilation strategies, fluid management, seizure control and osmotherapy); use of processed electroencephalogram monitoring; non-invasive assessment of intracranial pressure; prognostication; and rehabilitation techniques. Through this process, we have formulated practical recommendations to guide clinical practice in non-specialist centres.

Effect of Daytime versus Nighttime on Prehospital Care and Outcomes after Severe Traumatic Brain Injury

“…Traumatic brain injury (TBI) is a major contributor to morbidity and mortality in trauma victims and is a leading cause of death worldwide in patients under 45 years [1,2]. The treatment of TBI without unnecessary delay, to prevent secondary brain injury, is of the utmost importance [3]. Prehospital care provided to this category of patients focusses on the prevention of secondary brain injury and typically includes securing the airway by endotracheal intubation, mechanical ventilation, hemodynamic stabilization and the administration of hyperosmotic therapy [4].…”

Effect of Vitamin E on Serum MDA and Antioxidant Enzymes in Traumatic Brain Injury-Induced Rats

“…The severity of the damage isn't always immediately apparent and depends on various factors, including whether the external force was accidental or intentional, a direct impact, or acceleration, or deceleration, or the result of blast forces, and whether it involved penetration or not. Every year, around 70 million individuals suffer from TBI, with over 8 million people suffering from TBI-related disabilities [2]. In the United States alone, around 2.3 million cases of TBI occur yearly [3], with over 64,000 of these cases resulting in mortality, equating to nearly 176 TBI-related deaths every day [4].…”

Plasma D-dimer levels are a biomarker for in-hospital complications and long-term mortality in patients with traumatic brain injury

“…TBI is a systemic disease that can lead to organ dysfunction, including infections, respiratory and renal failure, myocardial injury, and multiple organ dysfunction in the acute phase, thereby increasing the length of hospital stays and costs ( Stocchetti and Zanier, 2016 ). After discharge, many patients with TBI require long-term rehabilitation to address physical disability, cognitive impairment, and psychological disorders, which impose considerable economic burdens on families and society ( Wiles et al, 2023 ). In addition, the poor prognosis of TBI substantially impacts patients, families, and healthcare providers.…”