Critical Care Pearls for Traumatic Brain Injury

• Avoid hypotension and hypoxia - SBP < 90 and/or PaO2 < 60 are associated with significant increases in morbidity and mortality
• Hypertonic saline remains controversial - a recent large, controlled trial did not show any early or long-term benefit
• ICP monitoring routinely recommended in patients with GCS < 8 - they have a 60% chance of increased ICP
• Maintain ICP < 20 mmHg and CPP > 60
• Supportive care
  • Elevate the head of bed > 30 degrees, if possible
  • Control fever
  • Provide analgesia and sedation
• Ventilator management - keep PaCO2 between 30-35 mmHg
• Surgery - last resort to controlling increased ICP
  • Decompressive craniotomy
  • Decompressive laparotomy