Traumatic Brain Injury

Curriculum Reference

13.9.5 (F) – Applies physiological and pharmacological principles to reduce the risk of secondary brain injury in patients presenting with a severe head injury.

13.11.5 Demonstrates knowledge and skills in resuscitation of the patient with major trauma.

13.11.6 Manages inter–hospital transfers of adults and children by land, including time-critical transfers, in line with local and regional policy.

13.11.7 Manages the resuscitation, stabilisation and transfer of patients with acute neurological deterioration.

15.9.2 Delivers safe peri-operative anaesthetic care to adults for emergency intracranial surgery, CSF diversions, spinal surgery and endovascular thrombectomy.

HiLLO 12: Doctors specialising in Intensive Care Medicine understand the special needs of, and are competent to manage patients with neurological diseases, both medical and those requiring surgery, which will include the management of raised intracranial pressure, central nervous system infections and neuromuscular disorders.

Review Articles

Traumatic brain injury: an evidence based review of the management (including anaesthesia for trauma craniotomy) BJA Education 13(6), 189-195, (2013)

The chronic and evolving neurological consequences of traumatic brain injury

Coagulopathy and haemorrhagic progression in traumatic brain injury: advances in mechanisms, diagnosis, and management

Severe traumatic brain injury: targeted management in the intensive care unit      

Further Reading (Including Key Trials)

Hypothermia for intracranial hypertension after traumatic brain injury (EUROTHERM)

Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients With Severe Traumatic Brain Injury (POLAR)

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial

Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension (RESCUE-ICP)

Decompressive Craniectomy in Diffuse Traumatic Brain Injury

Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial

A Trial of Intracranial-Pressure Monitoring in Traumatic Brain Injury

Effect of intravenous corticosteroids on death within 14 days in 10 008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial

COBI (COntinuous hyperosmolar therapy for traumatic Brain-Injured patients) trial protocol: a multicentre randomised open-label trial with blinded adjudication of primary outcome

TBI and uk epidemiology, complications and mortality

https://pubmed.ncbi.nlm.nih.gov/27884843/

National Guidance/Standards

Brain Trauma Foundation Guidelines 4th Edition

Brain Trauma Foundation: Guidelines for the Management of Pediatric Severe TBI, 3rd edition

NICE Guidelines – Head Injury

NACCS & SBNS position statement on calculation of CPP

Fluid therapy in neurointensive care patients: ESICM consensus and clinical practice recommendations

e-learning

https://litfl.com/traumatic-brain-injury-tbi-management/

ESICM Academy (Membership required)

Anaesthesia (e-LA) 03_20_04 Principles of the management of head injury and brain protection

Anaesthesia (e-LA) 03_20_05 Traumatic brain injury: an evidence-based review of management

Anaesthesia (e-LA) 03_20_06 Management and effects of raised ICP

Online Resources

Brain Trauma Foundation

Life in the fast lane (LITFL)

IMPACT prognostic calculator

Homepage for the CENTER-TBI project

Royal Melbourne Hospital – The Pediatric trauma manual

RCoA Audit Compendium

12.1 Prevention of hyperthermia in patients with acute Brian injury
12.2 Transfer of the patient with traumatic brain injury
12.5 Management of raised intracranial pressure in severe traumatic brain injury

FICM Recommendation

The management of traumatic brain injury should follow national and international best practice guidance 8.

Fever control to normothermia following traumatic brain injury, aneurysmal subarachnoid
haemorrhage, ischaemic stroke, or haemorrhagic stroke may improve outcome.

NACCS Video