TBI casualties with a GCS between 3 and 8 should be intubated if this has not been done during pre-hospital care. Artificial pulmonary ventilation should be maintained at values of PaCO2 35 mmHg (4.5 kPa). Hyperventilation is not indicated. If necessary, skeletal muscle relaxants can be added on.
Recommended central nervous system depressants are midazolam, propofol, or chlorpromazine. For analgesia, morphine or fentanyl are used. All available skeletal muscle relaxants can be used. Efficient sedation is preferred to skeletal muscle relaxation concerning circulatory parameters.
Blood volume and pressure should be maintained by fluid resuscitation. Fluid balance shoud be kept slightly negative in the first few days of injury but the absolute difference between fluid intake and output should not be further increased.
After ruling out intracranial hemorrhage, mannitol can be given as a series of bolus intravenous doses of 0.25 g/kg every 4 or 6 hours during the acute phase of TBI. ICP and blood osmolality should be monitored.
Furosemide should be given in a short infusion or as single bolus dose of 1 mg/kg if a sudden fluid retention occurs in the acute phase of TBI.
There are no convincing data that prove the administration of glucocorticoids to patients with traumatic brain injuries is effective. At present, glucocorticoids are not indicated for the treatment of traumatic brain injuries.
There are no convincing data that prove barbiturates efficient in improving the outcome of severe head injury.
There are no convincing data that advocate the administration of antiepileptic drugs to patients with traumatic brain injuries to prevent both the early and late posttraumatic seizures. It is recommended that early posttraumatic seizures should be treated with phenytoin.
There are no convincing data that prove psychostimulants efficient in improving outcome of severe head injury.
So far antioxidants have been discouraged for the treatment of patients with traumatic brain injuries since clinical studies have yet to prove their effectiveness.
There are no convincing data that prove calcium channel blockers efficient in improving the outcome of severe head injury.
Hypothermia is not recommended for. We maintain the body temperature below 37 degrees centigrade.
Coordinated by Karel ZITKO, M.D.
Last updated: 1999-09-06