Management of severe traumatic brain injury: A practical approach

Severe traumatic brain injury (TBI) is an entity that has maintained its prevalence, about to be considered the “silent epidemic” of this new millennium. Its epidemiological profile is changing. It is a heterogeneous entity, dynamic and changing over time. Its physiopathology is complex with profound impact at systemic level. Critical care is a key link in the chain of care. The advancement of multimodal neuromonitoring (MMM) techniques has made a remarkable contribution. The current therapy of severe TBI should follow the multidisciplinary precept, based on a deep scientific reasoning supported by pathophysiological knowledge. The bases of the same should be based in the following premises: to limit the primary damage and to avoid secondary and tertiary injuries through achieving the physiological homeostasis of the organism, to maintain adequate cerebral perfusion pressure (CPP), to avoid ischemia and cerebral hypoxia, and at the same time that elevations of intracranial pressure (ICP) are controlled and cerebral metabolism is maintained according to the energetic needs that the injury infringes.