Early resuscitation - what is changed in the treatment of Traumatic Brain Injury (TBI)
Journal
Journal of Anesthesia and Critical Care: Open access
Date Issued
2020-03-09
Author(s)
Demjanski, Vasko
Kishman, Aleksandar
DOI
10.15406/jaccoa.2020.12.00431
Abstract
Background: The classical therapeutic approaches to thetraumatic brain injury (TBI) are based on astandardized care and prevention of secondary brain injuries and insults.Brain is the most sensitive tissue to hypoxemia what consequently burdens maintenance of adequate circulation. The development of hypoxia hypoxemia during traumatic brain injury (TBI) with severe shock and anaemia is the main cause for the development of secondary brain injury, which is responsible for the high fatality of the TBI. Objectives and method: The aim of this review is to discuss the available literature and guidelines for this field and to find out the possible benefits of early resuscitation. Results: Initial resuscitation starts with infusions of isotonic crystalloid solutions (e.g. sodium chloride). The main goal of the treatment is to achieve normal blood pressure and adequate oxygen supply to the tissue. Aggressive resuscitation with excessive fluid load in TBI patients may aggravate the brain oedema. The data, about early use of blood and its products in TBI patients with severe haemorrhage are poor with controversial opinions. Conclusion: The resent published guidelines do not support any specific fluid or specific transfusion practices in this setting.