Critical Care Management of Traumatic Brain Injury

The critical care management of traumatic brain injury (TBI) continues to evolve with incremental understanding of secondary insults, the development of multimodal monitoring, and the recognition of neurologically focused critical care management of TBI patients being vital to their survival following TBI. As the epidemiology continues to evolve, our understanding and standardization of therapeutic approaches to limit secondary injury also continues to grow and evolve. Age-adjusted TBI hospitalizations and deaths are increasing in the elderly. The recognition and difficulty of managing dysfunction of multiple vital organs is central in this challenging patient population. The development of guidelines that address cerebral edema, targeted temperature management, venous thrombosis prevention, elevated intracranial pressure, brain tissue oxygenation, and decompressive craniectomy, as well as the potential for neuroprotection and hemorrhage limitation all represent advances in TBI care in the last 5 years. We present key established pathophysiologic concepts, new approaches, and potential areas for future research in the critical care management of TBI patients.