Pathophysiology and clinical management of moderate and severe traumatic brain injury in the ICU

Faheem G. Sheriff, Holly Hinson

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Moderate and severe traumatic brain injury (TBI) is the leading cause of morbidity and mortality among young individuals in high-income countries. Its pathophysiology is divided into two major phases: the initial neuronal injury (or primary injury) followed by secondary insults (secondary injury). Multimodality monitoring now offers neurointensivists the ability to monitor multiple physiologic parameters that act as surrogates of brain ischemia and hypoxia, the major driving forces behind secondary brain injury. The heterogeneity of the pathophysiology of TBI makes it necessary to take into consideration these interacting physiologic factors when recommending for or against any therapies; it may also account for the failure of all the neuroprotective therapies studied so far. In this review, the authors focus on neuroclinicians and neurointensivists, and discuss the developments in therapeutic strategies aimed at optimizing intracranial pressure and cerebral perfusion pressure, and minimizing cerebral hypoxia. The management of moderate to severe TBI in the intensive care unit is moving away from a pure threshold-based treatment approach toward consideration of patient-specific characteristics, including the state of cerebral autoregulation. The authors also include a concise discussion on the management of medical and neurologic complications peculiar to TBI as well as an overview of prognostication.

Original languageEnglish (US)
Pages (from-to)42-49
Number of pages8
JournalSeminars in Neurology
Volume35
Issue number1
DOIs
StatePublished - 2015

Fingerprint

Cerebrovascular Circulation
Wounds and Injuries
Brain Hypoxia-Ischemia
Brain Hypoxia
Intracranial Pressure
Therapeutics
Brain Injuries
Nervous System
Intensive Care Units
Homeostasis
Morbidity
Mortality
Traumatic Brain Injury

Keywords

  • intensive care unit
  • multimodality monitoring
  • pathophysiology
  • severe traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Pathophysiology and clinical management of moderate and severe traumatic brain injury in the ICU. / Sheriff, Faheem G.; Hinson, Holly.

In: Seminars in Neurology, Vol. 35, No. 1, 2015, p. 42-49.

Research output: Contribution to journalArticle

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