Resuscitation Strategies for Traumatic Brain Injury

Purpose of ReviewTraumatic brain injury (TBI) is a leading cause of morbidity and mortality; however, little definitive evidence exists about most clinical management strategies. Here, we highlight important differences between two major guidelines, the 2016 Brain Trauma Foundation guidelines and the Lund Concept, along with recent preclinical and clinical data.Recent FindingsWhile intracranial pressure (ICP) monitoring has been questioned, the majority of literature demonstrates benefit in severe TBI. The optimal cerebral perfusion pressure and ICP are yet unknown, but likely as important is the concept of ICP burden. The evidence for antihypertensive therapy is strengthening. Decompressive craniectomy improves mortality, but at the cost of increased morbidity. Plasma-based resuscitation has demonstrated benefit in multiple preclinical TBI studies.SummaryThe management of hemodynamics and intravascular volume are crucial in TBI. Based on recent evidence, ICP monitoring, antihypertensive therapy, minimal use of vasopressors/inotropes, and plasma resuscitation may improve outcomes.