Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition

1. Decompressive Craniectomy

2. Prophylactic Hypothermia

3. Hyperosmolar Therapy

4. Cerebrospinal Fluid Drainage

5. Ventilation Therapies

6. Anesthetics, Analgesics, and Sedatives

7. Steroids

8. Nutrition

9. Infection Prophylaxis

10. Deep Vein Thrombosis 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

see Decompressive craniectomy for severe traumatic brain injury.

see Prophylactic Hypothermia for severe traumatic brain injury.

see Intracranial pressure monitoring for severe traumatic brain injury.

see Severe traumatic brain injury guidelines.

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 1).

4th edition

Carney N, Totten AM, OʼReilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2016 Sep 20. [Epub ahead of print] PubMed PMID: 27654000.
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