Guidelines for the management of traumatic intracranial hypertension

Current treatment of severe head injury is based on various Guidelines. First guidelines for the management of severe head injury were published by Brain Trauma Foundation, New York, in 1995. Since then there was first revision of the guidelines done in 1997 and the second revision in 2000. Apart from American Guidelines there are also European Guidelines for the management of severe head injury and several national (regional) guidelines. All that suggests wide therapeutic variety in clinical practice but also necessity of using evidence based medicine (EBM) in the treatment of patients with severe traumatic brain injury. Most guidelines were created using the same process and the same published evidence and therefore came to similar conclusions. The most important thing in the treatment of traumatic coma patients for all guidelines is measurement of ICP (intracranial pressure) and keeping the CPP (cerebral perfusion pressure) above the 50 mmHg. These steps are critical to prevent secondary brain damage in euvolemic patients. Evidence based medicine guidelines are made not to replace the clinical experience but to assist to it. EBM Guidelines usually define the problems and the goals but do not explain how to reach the goals. Therefore, to have a continuous quality management in severely head injured patients ; all guidelines should be re-evaluated for compliance and updated regularly.