Management of severe traumatic brain injury in the acute phase

Abstract

Severe cranial trauma (SCT) is a major public health problem, with a high incidence and a high morbidity and mortality rate, mainly affecting young adults. SCT generally occurs as part of a polytrauma; its causes are still dominated by road accidents; clinically defined by the presence of a Glasgow score of less than or equal to 8.  Its initial management is based on appropriate resuscitation, which determines its prognosis. The main objective of this management is to prevent secondary cerebral lesions by controlling secondary cerebral attacks of systemic origin; more specifically, the two major attacks, hypoxia and hypotension. Once the patient has been intubated, ventilated and sedated, a brain scan can be used to determine post-traumatic lesions, in order to rule out a neurosurgical indication. It is therefore essential to refer patients with severe head trauma to an intensive care unit with a neurosurgical unit. Once the patient has been admitted to intensive care, specific monitoring is used to control cerebral and systemic haemodynamics. Treatment consists of preventing secondary cerebral lesions from developing.  The outcome of  SCT depends on the quality of its management, which must begin at the scene of the accident and be codified in regularly updated "GUIDELINES".                                                                                                                                 

Keywords : Severe head trauma - Neurosurgery - Specific monitoring - Secondary brain injury