Management of moderate to severe traumatic brain injury: an update for the intensivist

Geert Meyfroidt¹, Pierre Bouzat², Michael P Casaer³, Randall Chesnut⁴, Sophie Rym Hamada⁵, Raimund Helbok⁶, Peter Hutchinson⁷, Andrew I R Maas⁸, Geoffrey Manley⁹, David K Menon¹⁰, Virginia F J Newcombe¹⁰, Mauro Oddo¹¹, Chiara Robba¹², Lori Shutter¹³, Martin Smith¹⁴, Ewout W Steyerberg¹⁵, Nino Stocchetti¹⁶, Fabio Silvio Taccone¹⁷, Lindsay Wilson¹⁸, Elisa R Zanier¹⁹, Giuseppe Citerio^{20

21}

Affiliations

¹ Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium. geert.meyfroidt@kuleuven.be.
² Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France.
³ Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
⁴ Department of Neurological Surgery, Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
⁵ Anaesthesia and Critical Care Department, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Université Paris Sud, 78 rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France.
⁶ Department of Neurology, Neurocritical Care Unit, Innsbruck, Austria.
⁷ Department of Academic Neurosurgery, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
⁸ Department of Neurosurgery, University Hospital Antwerp, Edegem, Belgium.
⁹ Brain and Spinal Injury Center, Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA.
¹⁰ Department of Medicine, University Division of Anaesthesia, University of Cambridge, Cambridge, UK.
¹¹ Faculty of Biology and Medicine, Université de Lausanne, Lausanne, Switzerland.
¹² Anesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience and Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, University of Genoa, Genova, Italy.
¹³ Critical Care Medicine, Neurology, and Neurosurgery, UPMC/University of Pittsburgh School of Medicine, Pittsburgh, Pensylvania, USA.
¹⁴ Neurocritical Care Unit, The National Hospital for Neurology and Neurosurgery, University College London Hospitals and National Institute for Health Research Biomedical Research Centre, London, UK.
¹⁵ Clinical Biostatistics and Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
¹⁶ Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
¹⁷ Department of Intensive Care, Université Libre de Bruxelles (ULB) and Laboratoire de Recherche Experimentale, Department of Intensive Care, Hôpital Erasme, Brussels, Belgium.
¹⁸ Division of Psychology, University of Stirling, Stirling, UK.
¹⁹ Laboratory of Acute Brain Injury and Therapeutic Strategies, Dept of Neuroscience, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy.
²⁰ School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
²¹ Neurointensive Care Unit, San Gerardo Hospital, Monza, Italy.

PMID: 35595999
DOI: 10.1007/s00134-022-06702-4

Review

Management of moderate to severe traumatic brain injury: an update for the intensivist

Geert Meyfroidt et al. Intensive Care Med. 2022 Jun.

. 2022 Jun;48(6):649-666.

doi: 10.1007/s00134-022-06702-4. Epub 2022 May 20.

Authors

Affiliations

¹ Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium. geert.meyfroidt@kuleuven.be.
² Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France.
³ Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
⁴ Department of Neurological Surgery, Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
⁵ Anaesthesia and Critical Care Department, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Université Paris Sud, 78 rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France.
⁶ Department of Neurology, Neurocritical Care Unit, Innsbruck, Austria.
⁷ Department of Academic Neurosurgery, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
⁸ Department of Neurosurgery, University Hospital Antwerp, Edegem, Belgium.
⁹ Brain and Spinal Injury Center, Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA.
¹⁰ Department of Medicine, University Division of Anaesthesia, University of Cambridge, Cambridge, UK.
¹¹ Faculty of Biology and Medicine, Université de Lausanne, Lausanne, Switzerland.
¹² Anesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience and Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, University of Genoa, Genova, Italy.
¹³ Critical Care Medicine, Neurology, and Neurosurgery, UPMC/University of Pittsburgh School of Medicine, Pittsburgh, Pensylvania, USA.
¹⁴ Neurocritical Care Unit, The National Hospital for Neurology and Neurosurgery, University College London Hospitals and National Institute for Health Research Biomedical Research Centre, London, UK.
¹⁵ Clinical Biostatistics and Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
¹⁶ Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
¹⁷ Department of Intensive Care, Université Libre de Bruxelles (ULB) and Laboratoire de Recherche Experimentale, Department of Intensive Care, Hôpital Erasme, Brussels, Belgium.
¹⁸ Division of Psychology, University of Stirling, Stirling, UK.
¹⁹ Laboratory of Acute Brain Injury and Therapeutic Strategies, Dept of Neuroscience, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy.
²⁰ School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
²¹ Neurointensive Care Unit, San Gerardo Hospital, Monza, Italy.

PMID: 35595999
DOI: 10.1007/s00134-022-06702-4

Erratum in

Correction to: Management of moderate to severe traumatic brain injury: an update for the intensivist.
Meyfroidt G, Bouzat P, Casaer MP, Chesnut R, Hamada SR, Helbok R, Hutchinson P, Maas AIR, Manley G, Menon DK, Newcombe VFJ, Oddo M, Robba C, Shutter L, Smith M, Steyerberg EW, Stocchetti N, Taccone FS, Wilson L, Zanier ER, Citerio G. Meyfroidt G, et al. Intensive Care Med. 2022 Jul;48(7):989-991. doi: 10.1007/s00134-022-06759-1. Intensive Care Med. 2022. PMID: 35723687 No abstract available.

Abstract

Traumatic brain injury (TBI) remains one of the most fatal and debilitating conditions in the world. Current clinical management in severe TBI patients is mainly concerned with reducing secondary insults and optimizing the balance between substrate delivery and consumption. Over the past decades, multimodality monitoring has become more widely available, and clinical management protocols have been published that recommend potential interventions to correct pathophysiological derangements. Even while evidence from randomized clinical trials is still lacking for many of the recommended interventions, these protocols and algorithms can be useful to define a clear standard of therapy where novel interventions can be added or be compared to. Over the past decade, more attention has been paid to holistic management, in which hemodynamic, respiratory, inflammatory or coagulation disturbances are detected and treated accordingly. Considerable variability with regards to the trajectories of recovery exists. Even while most of the recovery occurs in the first months after TBI, substantial changes may still occur in a later phase. Neuroprognostication is challenging in these patients, where a risk of self-fulfilling prophecies is a matter of concern. The present article provides a comprehensive and practical review of the current best practice in clinical management and long-term outcomes of moderate to severe TBI in adult patients admitted to the intensive care unit.

Keywords: Cerebral perfusion pressure; Intensive care unit; Intracranial pressure; Neuromonitoring; Pre-hospital management; Traumatic brain injury.

PubMed Disclaimer

Comment in

Brain tissue oxygen tension monitoring for traumatic brain injury: limitations and alternatives.
Wong CE, Lee PH, Huang CC, Huang YT, Lee JS. Wong CE, et al. Intensive Care Med. 2022 Aug;48(8):1108-1109. doi: 10.1007/s00134-022-06767-1. Epub 2022 Jun 10. Intensive Care Med. 2022. PMID: 35687161 No abstract available.
Global and focal monitoring in traumatic brain injury: a never-ending story?
Meyfroidt G, Citerio G. Meyfroidt G, et al. Intensive Care Med. 2022 Aug;48(8):1110-1111. doi: 10.1007/s00134-022-06789-9. Epub 2022 Jul 1. Intensive Care Med. 2022. PMID: 35776163 No abstract available.

References

1. GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(1):56-87. https://doi.org/10.1016/S1474-4422(18)30415-0 . [Erratum in: Lancet Neurol. 2021 Dec;20(12):e7]
1. Stocchetti N, Taccone FS, Citerio G et al (2015) Neuroprotection in acute brain injury: an up-to-date review. Crit Care 19:186. https://doi.org/10.1186/s13054-015-0887-8 - DOI
1. Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma-Inj Infect Critic Care 34(2):216–222 - DOI
1. Spaite DW, Hu C, Bobrow BJ, Chikani V, Sherrill D, Barnhart B et al (2017) Mortality and prehospital blood pressure in patients with major traumatic brain injury: implications for the hypotension threshold. JAMA Surg 152(4):360–368 - DOI
1. Spahn DR, Bouillon B, Cerny V et al (2019) The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care 23:98. https://doi.org/10.1186/s13054-019-2347-3 - DOI

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Springer
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Management of moderate to severe traumatic brain injury: an update for the intensivist

Affiliations

Management of moderate to severe traumatic brain injury: an update for the intensivist

Authors

Affiliations

Erratum in

Abstract

Comment in

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous