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.
Keywords
severe traumatic brain injury - pathophysiology - multimodality monitoring - intensive
care unit
