Traumatic Brain Injury: Evidence-Based Medicine, Diagnosis, and Treatment

Traumatic brain injury (TBI) is a major cause of death and disability worldwide. The initial trauma triggers a complex cascade of cellular and tissue changes with subsequent secondary injury to the vulnerable brain. Injury can result from derangements of multiple physiological parameters including blood pressure, brain oxygenation, intracranial pressure, and temperature. The monitoring and treatment of the multiple physiological derangements that often occur after TBI are important aspects of the intensive care management of this patient population, but the specific treatment thresholds for each variable and their relationship to outcome are varied. The focus of this chapter is on severe traumatic brain injury and its treatment with an emphasis on the updated recommendations from the Fourth Edition of the “Brain Trauma Foundation’s Guidelines for the Management of Severe Traumatic Brain Injury.”