Critical care management of head injury

Severe traumatic brain injury (TBI) is a significant cause of morbidity and mortality. The intensive care management of TBI requires a coordinated and comprehensive approach to treatment, including strategies to prevent secondary brain injury by avoidance of systemic physiological disturbances, such as hypotension and hypoxaemia, and maintenance of adequate cerebral perfusion and oxygenation. There have been marked improvements in the treatment of patients with severe TBI over the last decade and management advances in the pre-hospital setting and emergency department have recently been extended into the intensive care unit. The management of head injury has undergone extensive revision as evidence accumulates that established practices are not as effective or innocuous as previously believed. Management protocols have evolved with international consensus, providing guidelines that assist clinicians in delivering optimal care. Improved diagnostic and monitoring modalities are improving our understanding of the pathophysiology of head injury and allowing the delivery of individualized therapy. This review identifies the important aspects of the critical care management of TBI.