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Review
. 2023 Sep 22;85(12):5983-6000.
doi: 10.1097/MS9.0000000000001291. eCollection 2023 Dec.

Evidence-based management of adult traumatic brain injury with raised intracranial pressure in intensive critical care unit at resource-limited settings: a literature review

Kanbiro Gedeno  1 , Derartu Neme  2 , Bedru Jemal  2 , Zemedu Aweke  2   3 , Astemamagn Achule  1 , Kuchulo Geremu  1 , Tesfanew Bekele Uddo  4
Affiliations
Review

Evidence-based management of adult traumatic brain injury with raised intracranial pressure in intensive critical care unit at resource-limited settings: a literature review

Kanbiro Gedeno et al. Ann Med Surg (Lond). .

Abstract

Background: In underdeveloped countries, there is a greater incidence of mortality and morbidity arising from trauma, with traumatic brain injury (TBI) accounting for 50% of all trauma-related deaths. The occurrence of elevated intracranial pressure (ICP), which is a common pathophysiological phenomenon in cases of TBI, acts as a contributing factor to unfavorable outcomes. The aim of this systematic review is to analyze the existing literature regarding the management of adult TBI with raised ICP in an intensive critical care unit, despite limited resources.

Methods: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Search engines such as PubMed, the Cochrane database, and Google Scholar were utilized to locate high-level evidence that would facilitate the formation of sound conclusions.

Result: A total of 11 715 articles were identified and individually assessed to determine their eligibility for inclusion or exclusion based on predetermined criteria and outcome variables. The methodological quality of each study was evaluated using recommended criteria. Ultimately, the review consisted of 51 articles.

Conclusion: Physical examination results and noninvasive assessments of the optic nerve sheath diameter (ONSD) via sonography are positively associated with elevated ICP, and are employed as diagnostic and monitoring tools for elevated ICP in resource-limited settings. Management of elevated ICP necessitates an algorithmic approach that utilizes prophylactic measures and acute intervention treatments to mitigate the risk of secondary brain injury.

Keywords: critical care; head injury; hyperosmolar therapy; hyperventilation; intracranial hypertension.

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Conflict of interest statement

Nothing to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Flowchart for selection of studies by PRISMA flow diagram. Sources: adapted from the PRISMA 2020 statement: an updated guideline for reporting systematic reviews, 2021.
Figure 2
Figure 2
Management of TBI with ICP algorithm. Flow chart for diagnosis, monitoring and management of traumatic brain injury with raised ICP at resource-limited ICU.
See this image and copyright information in PMC

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