Therapeutic Options in Neurocritical Care

doi:10.1017/9781108355247.015

Chapter 13 - Therapeutic Options in Neurocritical Care

Optimising Brain Physiology

Published online by Cambridge University Press: 28 April 2020

Chiara Robba and

Edited by

Maggie Whyte and

Peter C. Whitfield: Affiliation:
Derriford Hospital, Plymouth
Jessie Welbourne: Affiliation:
University Hospitals, Plymouth
Elfyn Thomas: Affiliation:
Derriford Hospital, Plymouth
Fiona Summers: Affiliation:
Aberdeen Royal Infirmary
Maggie Whyte: Affiliation:
Aberdeen Royal Infirmary
Peter J. Hutchinson: Affiliation:
Addenbrooke’s Hospital, Cambridge

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Summary

Traumatic Brain Injury (TBI) is a major cause of mortality and morbidity. The severity of primary injury is the major determinant of outcome and occurs during the initial insult, as result of displacement of the physical structures of the brain. However, several factors can occur in the post-injury phase and have also been independently demonstrated to contribute to ‘secondary brain injury’ and to worsen patients’ outcome. These include intracranial hypertension, systemic hypotension, hypoxemia, hyperpyrexia, hypocapnoea and hyper- and hypoglycaemia; many of these factors are amenable to clinical manipulation. It is not well understood how much primary and secondary injuries respectively contribute towards the clinical manifestations of TBI. The exact mechanisms leading to secondary brain injury are not fully elucidated, but exacerbation of cerebral ischaemia and cerebral hypoperfusion are thought to be crucial factors. The integrated management of these factors forms the basis for specialist neurocritical care.

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Type: Chapter
Information: Traumatic Brain Injury
A Multidisciplinary Approach
, pp. 146 - 163

DOI: https://doi.org/10.1017/9781108355247.015 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2020

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