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

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

Current Opinion in Anesthesiology: October 2014 - Volume 27 - Issue 5 - p 459–464
doi: 10.1097/ACO.0000000000000105
NEUROANESTHESIA: Edited by Kristin Engelhard
Editor's Choice

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.

aClinical Lead Neuro Intensive Care, Queens Hospital, Barking Havering and Redbridge NHS Trust, London

bHonorary Senior Clinical Lecturer, Queen Mary's, University of London

cSpecialist Registrar, Anesthesia and Intensive Care Medicine, Barts and The London School of Anesthesia, London, UK

Correspondence to Dhuleep S. Wijayatilake, Neurointensive Care Unit, Queens Hospital, Rom Valley Way, Romford, Essex, RM7 0AG, UK. Tel: +44 1708 503727; fax: +44 1708 503763; e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.