Table of contents
Traumatic brain injury
What's new
Updated 2024 ESAIC/AATS guidelines for perioperative venous thromboembolism prophylaxis in patients with traumatic brain injury.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of traumatic brain injury are prepared by our editorial team based on guidelines from the European Hip Society (EHS/EAU/ISTH/EACTAIC/EACTS/AATS/ESTS/EBCOG/EKS/ESAIC/NATA/SRLF/EURAPS 2024), the European Society of Intensive Care Medicine (ESICM 2024,2017), the Neurocritical Care Society (NCS 2024), the Surgical Infection Society Europe (SIS-E/GAIS/WSES/WSIS/AAST 2024), the French Society of Emergency Medicine (SFMU/SFAR 2022), the ...
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Diagnostic investigations
Indications for testing: as per EAST 2020 guidelines, use a screening protocol for the detection of blunt cerebrovascular injury in adult patients with blunt polytrauma.
A
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CT
MRI
CTA
Screening for central hypothyroidism
Respiratory support
Prophylactic hyperventilation: as per BTF 2017 guidelines, avoid prolonged prophylactic hyperventilation with PaCO2 =< 25 mmHg.
D
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Tracheostomy
Medical management
Treatment targets: as per BTF 2017 guidelines, consider maintaining SBP above the following thresholds to decrease mortality and improve outcomes:
≥ 110 mmHg or above for patients 15 to 49 years of age
≥ 100 mmHg for patients 50 to 69 years of age
> 110 mmHg for patients > 70 years of age.
C
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Fluid management
Mannitol
Sedative agents
Corticosteroids
Neuromuscular blockade
Thromboprophylaxis
Seizure prophylaxis
Antibiotic prophylaxis
Ventilator-associated pneumonia prophylaxis
Inpatient care
ICP monitoring
As per BTF 2017 guidelines:
Perform ICP monitoring in patients with severe TBI, to reduce in-hospital and 2-week post-injury mortality.
B
Consider using a combination of ICP values and clinical and brain CT findings to guide management in patients with TBI.
C
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Jugular bulb monitoring
Nonpharmacologic interventions
Therapeutic procedures
External ventricular drainage: as per BTF 2017 guidelines, consider performing CSF drainage to lower ICP in patients with an initial GCS < 6 during the first 12 hours after injury.
C
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Induced hypothermia
Perioperative care
Perioperative thromboprophylaxis: as per AATS/EACTAIC/EACTS/EAU/EBCOG/EHS/EKS/ESAIC/ESTS/EURAPS/ISTH/NATA/SRLF 2024 guidelines, consider administering early prophylaxis with LMWH within 48 hours after injury in nonoperated patients with TBI and no progression of ICH on CT 24 hours after the injury.
C
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Surgical interventions
Decompressive craniectomy
As per BTF 2017 guidelines:
Do not perform bifrontal decompressive craniectomy as a means to improve outcomes in patients with severe and diffuse TBI (without mass lesions), although recognizing that this procedure is effective to reduce ICP and may decrease ICU length of stay.
D
Perform a large frontotemporoparietal decompressive craniectomy (not less than 12×15 cm or 15 cm diameter) over a small frontotemporoparietal decompressive craniectomy for reduced mortality and improved neurologic outcomes in patients with severe TBI.
B