Updates in traumatic brain injury management: brain oxygenation, middle meningeal artery embolization and new protocols

Abstract

Traumatic brain injury (TBI) confers significant morbidity and mortality, and is a pathology often encountered by trauma surgeons. Several recent trials have evaluated management protocols of patients with severe TBI. The Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II trial (BOOST-II) evaluated efficacy and feasibility of brain oxygen measurement in severe TBI. BOOST phase 3 trial (BOOST-3) and two ongoing trials look to measure functional outcomes in this population. Furthermore, middle meningeal artery embolization has now become standard therapy for adult patients with chronic subdural hematoma (SDH) and has increasing popularity in those with recurrent SDH as an alternative to surgical intervention. In this manuscript, we review the literature, ongoing trials, and discuss current updates in the management of TBI.

Keywords: Brain Injuries, Traumatic; Clinical Protocols; Head Injuries, Closed; randomized controlled trial.

Figure 1

THE MANTLE recommendations for optimization of cerebral oxygenation. Adopted from Godoy DA, et al. SvjO2, venous jugular oxygen content; PtiO2, partial pressure of brain tissue oxygen; CPP, cerebral perfusion pressure; SABP, systolic arterial blood pressure; PaO2, arterial partial pressure of oxygen; Vt, tidal volume; RR, respiratory rate; PP, plateau pressure; DP, driving pressure; PI, pulsatility index; MP, mechanical power; ICP, intracranial pressure; ONSD, optic nerve sheath diameter; CT, computed tomography.