Management of Acute Traumatic Brain Injury

Traumatic brain injury (TBI) is a major cause of morbidity and mortality. Acute TBI management is focused on the prevention of secondary injury. Basic principles of critical care such as blood pressure management, mechanical ventilation, sedation, enteral nutrition, and sepsis treatment need to be uniquely tailored to the needs of the TBI patient. Intracranial hypertension is best approached with tiered escalation of care. While the Brain Trauma Foundation (BTF) has provided evidence-based guidelines for TBI management, the strength of recommendations is limited by lack of high-quality studies. Therefore, it is also useful to take into account the best practice guidelines put forth by the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP). Combining recommendations from the BTF and ACS TQIP, as well as clinical judgment, yields a practical and systematic approach to the individual TBI patient.