Traumatic brain injury: initial resuscitation and transfer

Traumatic brain injury (TBI) is common and carries a high morbidity and mortality. Initial management of the traumatic brain injury patient is directed toward preventing and limiting secondary brain injury while facilitating rapid transport to an appropriate facility capable of providing definitive neurocritical care. During resuscitation of the TBI patient, management is directed at correcting and maintaining mean arterial pressure (MAP), blood glucose, PaO2 and PaCO2 within their normal ranges. After the initial resuscitation, management is directed at limiting secondary damage to the brain that occurs in response to inflammatory changes, expanding haematomas, cellular swelling, seizures, and systemic complications such as haemodynamic or pulmonary changes, fever and pain. The transport of critically ill brain injured patients carries inherent risks. Although both intrahospital and interhospital transport must comply with regulations, patient safety is enhanced during transport by establishing an organised, efficient process supported by appropriate equipment and personnel. This review examines the evidence base for the initial resuscitation and transfer of head-injured patients.