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Guidelines For The Management of Severe Traumatic Brain Injury 4th Edition
Guidelines For The Management of Severe Traumatic Brain Injury 4th Edition
Management of
Severe Traumatic
Brain Injury 4th
Edition
Dr Babita Gupta
Professor, (JPNATC),
AIIMS, New Delhi
Introduction
Published in 2016 - Endorsed by Brain Trauma
Foundation, American Association of
Neurological Surgeons, Congress of Neurological
Surgeons
AIM: To have evidence-based recommendations
To encourage use of evidence-based treatments
that exist, & to encourage creativity in treatment
& research in areas where evidence doesn’t exist
Quality Assessment of Individual Studies
The study are classified as Class 1, 2, or 3
• Class 1: Good-quality randomized trials
• Level I : High-quality
• Level II A : Moderate-quality
• Level II B and III: Low-quality
Scope of the guideline
PART I: TREATMENTS
ANESTHETICS,
VENTILATION
ANALGESICS, AND STEROIDS NUTRITION
THERAPIES
SEDATIVES
DEEP VEIN
INFECTION SEIZURE
THROMBOSIS
PROPHYLAXIS PROPHYLAXIS
PROPHYLAXIS
Decompressive Craniectomy
Cerebral edema
• Primary injury
• Secondary injury
Variations in
• Surgical techniques
• Timing
• Patient populations
Decompressive Craniectomy
Recommedations
Level I
Insufficient evidence
Level II A
Bifrontal DC is not recommended to improve outcomes as measured
by the Glasgow Outcome Scale–Extended (GOS-E) score at 6 months
post-injury in severe TBI patients with diffuse injury
However, this procedure has been demonstrated to reduce ICP and to
minimize days in the intensive care unit (ICU)
Hypothermia : Preserve cells and tissue
EVD
• Closed position: Monitor
intracranial pressure (CP)
• Open position: Drainage of CSF
Cerebrospinal Fluid Drainage
Recommendations
Level An EVD system zeroed at the midbrain
with continuous drainage of CSF may
III be considered to lower ICP burden
more effectively than intermittent use
Level II B
• Transgastric jejunal feeding is recommended to reduce the
incidence of ventilator- associated pneumonia
Infection Prophylaxis
Severe traumatic brain injury can increase a patient’s
susceptibility to infection
• Use of mechanical ventilation
• Invasive monitoring
Advanced cerebral
monitoring
Intracranial pressure monitoring
Intracranial Pressure Monitoring
Recommendations
Management of severe TBI patient using
Level II B information from ICP monitoring is
recommended to reduce in-hospital and
2-week post-injury mortality
Cerebral Perfusion Pressure Monitoring
Anesthetic agent
• Administration of barbiturates as prophylaxis against the
development of intracranial hypertension is not recommended