Traumatic Brain Injury: Intraoperative Management and Intensive Care Unit Multimodality Monitoring

Krassimir Denchev; Jonathan Gomez; Pinxia Chen; Kathryn Rosenblatt

doi:10.1016/j.anclin.2022.11.003

Traumatic Brain Injury: Intraoperative Management and Intensive Care Unit Multimodality Monitoring

Anesthesiol Clin. 2023 Mar;41(1):39-78. doi: 10.1016/j.anclin.2022.11.003.

Authors

Krassimir Denchev¹, Jonathan Gomez², Pinxia Chen³, Kathryn Rosenblatt⁴

Affiliations

¹ Department of Anesthesiology, Wayne State University, 44555 Woodward Avenue, SJMO Medical Office Building, Suite 308, Pontiac, MI 48341, USA.
² Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA.
³ Department of Anesthesiology and Critical Care Medicine, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA.
⁴ Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA; Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA. Electronic address: krosenb3@jhmi.edu.

PMID: 36872007
DOI: 10.1016/j.anclin.2022.11.003

Abstract

Traumatic brain injury is a devastating event associated with substantial morbidity. Pathophysiology involves the initial trauma, subsequent inflammatory response, and secondary insults, which worsen brain injury severity. Management entails cardiopulmonary stabilization and diagnostic imaging with targeted interventions, such as decompressive hemicraniectomy, intracranial monitors or drains, and pharmacological agents to reduce intracranial pressure. Anesthesia and intensive care requires control of multiple physiologic variables and evidence-based practices to reduce secondary brain injury. Advances in biomedical engineering have enhanced assessments of cerebral oxygenation, pressure, metabolism, blood flow, and autoregulation. Many centers employ multimodality neuromonitoring for targeted therapies with the hope to improve recovery.

Keywords: Brain tissue oxygen monitoring; Cerebral autoregulation; Cerebral microdialysis; Intracranial pressure; Multimodality neuromonitoring; Near-infrared spectroscopy; Transcranial doppler; Traumatic brain injury.

Publication types

Review

MeSH terms

Brain
Brain Injuries*
Brain Injuries, Traumatic*
Critical Care
Humans
Intensive Care Units