2. Prophylactic Hypothermia
3. Hyperosmolar Therapy
4. Cerebrospinal Fluid Drainage
5. Ventilation Therapies
6. Anesthetics, Analgesics, and Sedatives
9. Infection Prophylaxis
11. Seizure Prophylaxis: see Posttraumatic seizures treatment.
12. Intracranial Pressure Monitoring
13. Cerebral Perfusion Pressure Monitoring
14. Advanced Cerebral Monitoring
15. Blood Pressure Thresholds
16. Intracranial Pressure Thresholds
17. Cerebral Perfusion Pressure Thresholds
18. Advanced Cerebral Monitoring Thresholds
In the most recent publication of the Fourth Edition of Guidelines for the Management of Severe traumatic brain injury (TBI), the Joint Guidelines Committee provided an impressive review of updated literature and subsequent new guidelines.
The scope and purpose of the Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. is 2-fold: to synthesize the available evidence and to translate it into recommendations. This document provides recommendations only when there is evidence to support them. As such, they do not constitute a complete protocol for clinical use.
The intention is that these recommendations be used by others to develop treatment protocols, which necessarily need to incorporate consensus and clinical judgment in areas where current evidence is lacking or insufficient.
Carney et al. think it is important to have evidence-based recommendations to clarify what aspects of practice currently can and cannot be supported by evidence, to encourage use of evidence-based treatments that exist, and to encourage creativity in treatment and research in areas where evidence does not exist. The communities of neurosurgery and neurointensive care have been early pioneers and supporters of evidence based medicine and plan to continue in this endeavor. The complete guideline document, which summarizes and evaluates the literature for each topic, and supplemental appendices (A-I) are available online at https://www.braintrauma.org/coma/guidelines 1).