Updates in the management of intracranial pressure in traumatic brain injury.

PURPOSE OF REVIEW: Traumatic brain injury remains a common and often debilitating event across the world, producing significant burdens upon health and social care. Effective neurocritical care coupled with timely and appropriate neurosurgical intervention can produce significant improvements in patient outcome. There remains controversy about how best to manage intracranial pressure on the ICU; we review the recent literature addressing a number of key variables.

RECENT FINDINGS: Treatment of elevations in intracranial pressure can begin at the roadside and end on the ICU unit via a number of routes. Prehospital physician-led care may produce significant benefits in outcome which extend beyond airway management. Routine use of cooling worsens the respiratory outcomes without large improvement in neurological endpoints. The use of brain tissue oxygen monitoring is extending and increasingly used to guide management. Decompressive craniectomy in refractory intracranial hypertension has been associated with poor functional outcomes; a large multicentre trial is currently comparing it against barbiturate coma.

SUMMARY: The role of the neurointensivist in outcome for patients who suffer severe traumatic brain injury is key. Targeted therapies are allowing early detection and manipulation of brain ischaemia leading to more individualized treatment.