PATHOPHYSIOLOGY

OF TRAUMATIC
BRAIN INJURY

Siti Chasnak Saleh

Dept. Anesthesiology & Reanimation
Airlangga Univ / Soetomo Hosp
Surabaya

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 DEFINITION OF TBI

Traumatic brain injury is an insult to the brain,

not of degenerative or congenital nature caused
by an external physical force that may produce a
diminished or altered state of consciousness
which result in an impairement of cognitive
abilities or physical functioning. It can also result
in the disturbance of behavioral or emotional
functioning.

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 Processes that influence secondary injury

Systemic CNS

• hypoxia • hematoma
• hypotension • brain edema
• anemia • brain herniation
• hyperthermia • seizures
• hyper/hypocarbia • hydrocephalus
• fluid imbalance • ischemia

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Am J Physiol Heart Circ Physiol 311: H1118–H1131, 2016.
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Bouzat et al. Annals of Intensive Care 2013, 3:23
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 EARLY MANAGEMENT

Prevention secondary brain injury:

▪ Airway
▪ Breathing
▪ Circulate
▪ Disability
▪ Environment

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 LOWERING ICP
▪ Head-bed elevation 300
▪ Adequate oxygenation
▪ Normocapnea
▪ Normovolemia
▪ Temperature control
▪ Treatment of seizure

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 Positioning
• As long as MAP > 60
– Elevation of HOB to
30° will reduce ICP
– Reduction of JVP
– Straight head position
– Do not elevate to >45°
as may drop CPP and
trigger abnormal ICP
rise.

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 CONCLUSION

• Severe traumatic brain injury is a clinical situation

in which basic resuscitation and management has
to be initiated before a complete investigation of
the full extent of injuries can be performed.

• Management should be based on the knowledge

of pathophysiology of brain injury.

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