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Current Opinion in Anaesthesiology:
doi: 10.1097/ACO.0000000000000105
NEUROANESTHESIA: Edited by Kristin Engelhard

What's new in the management of traumatic brain injury on neuro ICU?

Wijayatilake, Dhuleep S.a,b; Shepherd, Stephen J.c

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Abstract

Purpose of review

In recent years, we have begun to better understand how to monitor the injured brain, look for less common complications and importantly, reduce unnecessary and potentially harmful intervention. However, the lack of consensus regarding triggers for intervention, best neuromonitoring techniques and standardization of therapeutic approach is in need of more careful study. This review covers the most recent evidence within this exciting and dynamic field.

Recent findings

The role of intracranial pressure monitoring has been challenged; however, it still remains a cornerstone in the management of the severely brain-injured patient and should be used to compliment other techniques, such as clinical examination and serial imaging.

The use of multimodal monitoring continues to be refined and it may be possible to use them to guide novel brain resuscitation techniques, such as the use of exogenous lactate supplementation in the future.

Summary

Neurocritical care management of traumatic brain injury continues to evolve. However, it is important not to use a ‘one-treatment-fits-all’ approach, and perhaps look to use targeted therapies to individualize treatment.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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