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[Craniocerebral injuries: initial treatment and at resuscitation units]
A Galán Fernández1, L Fernández-Quero, J Navia
1Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital General Universitario Gregorio Marañón, Madrid.
Insights
Head injury is a leading cause of death in young adults. Optimal management focuses on maintaining cerebral perfusion pressure and avoiding secondary brain injury, rather than solely controlling intracranial pressure.
Area of Science:
- Neuroscience
- Trauma Surgery
- Critical Care Medicine
Context:
- Head injury is a significant cause of mortality and disability in individuals under 45.
- Understanding the pathophysiology of head trauma is crucial for effective patient management.
- Intensive care units play a vital role in the recovery of patients with head injuries.
Purpose:
- To review the pathophysiological aspects of head injury.
- To outline initial treatment and management strategies for head-injured patients in intensive care.
- To emphasize key therapeutic goals and challenges in managing head trauma.
Summary:
- The primary goal in treating head injury is to ensure adequate cerebral perfusion pressure (CPP).
- Avoiding secondary lesions, particularly arterial hypotensive events, is critical for patient prognosis.
- The review advocates for judicious use of sedation and analgesia, alongside maintaining normal physiological parameters and monitoring, rejecting indiscriminate hyperventilation and mannitol therapy.
Impact:
- Provides evidence-based guidance for managing head injuries in critical care settings.
- Highlights the importance of monitoring cerebral perfusion pressure for improved patient outcomes.
- Informs clinical practice regarding the avoidance of potentially harmful treatments like hyperventilation and mannitol.
Abstract:
Head injury is the main cause of death or disability among under-45-year-olds. This review covers the main pathophysiological aspects of head injury as well as initial treatment and management in the intensive care recovery ward. The chief therapeutic aim is to maintain adequate cerebral perfusion pressure rather than to maintain normal levels of intracranial pressure. An important challenge is to avoid development of secondary lesions, and in this context arterial hypotensive events that affect prognosis and the survival of such patients merit special attention. We reject treatment based on indiscriminate use of hyperventilation and mannitol and underline the importance of providing adequate sedation and analgesia while maintaining normal flow and pressure and adequate monitoring of such patients.