Management of patients with traumatic brain injury: Our strategy

Over the past 10 years, we have been managing patients with severe head injury on the basis of guidelines published in the U.S.A., Europe and Japan. Here we report our strategy for managing patients with severe head injury, including hypothermia therapy. Intracranial hematomas are evacuated, and external decompression is performed. Cerebrospinal fluid (CSF) drainage and/or implantation of an intracranial pressure (ICP) sensor is also performed. For patients with diffuse axonal injury (DAI), a CSF drainage catheter and/or ICP sensor is inserted. In patients for whom hypothermia therapy is appropriate, brain and body temperatures are maintained at 32-33 degrees C for 3-8 days. Intracranial pressure, temperatures of the brain, jugular vein, bladder and pulmonary artery, and O-2 saturation in the jugular vein are measured continuously. intensive care using various monitoring tools is necessary for patient management. Systemic circulation is monitored using a Swan-Ganz catheter. Blood gas, blood cells, and chemical data are frequently checked and abnormal values are corrected without delay. The purpose of this management approach is to control ICP and to inhibit secondary damage that can spread from the primary site of injury. In DAI, so-called secondary axotomy should be prevented.