CURRENT CONTROVERSIES IN THE MANAGEMENT OF PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY

doi:10.1111/j.1445-2197.2006.03674.x

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Wiley InterScience

ANZ Journal of Surgery

Volume 76 Issue 3, Pages 163 - 174

Published Online: 9 Mar 2006

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REVIEW ARTICLE

CURRENT CONTROVERSIES IN THE MANAGEMENT OF PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY

Alexios A. Adamides,*†‡ Craig D. Winter,* Philip M. Lewis,* D. James Cooper,†§ Thomas Kossmann†¶ Jeffrey V. Rosenfeld*‡

Departments of * Neurosurgery , ¶Traumaand §Intensive Care, The Alfred Hospital, †National Trauma Institute, and ‡Department of Surgery, Monash University, Melbourne, Victoria, Australia

Correspondence: Professor Jeffrey V. Rosenfeld, Department of Neurosurgery, The Alfred Hospital, PO Box 315, Prahran, Vic. 3181, Australia.
Email: j.rosenfeld@alfred.org.au

A. A. Adamides BMBS, BMedSci; C. D. Winter MB, BChir, FRCS (SN); P. M. Lewis BAppSc; D. J. Cooper FRACP, MO; T. Kossmann FRACS, MD; J. V. Rosenfeld FRACS, MS.

KEYWORDS

traumatic brain injury • review

ABSTRACT

Background: Traumatic brain injury is a major cause of mortality and morbidity, particularly among young men. The efficacy and safety of most of the interventions used in the management of patients with traumatic brain injury remain unproven. Examples include the 'cerebral perfusion pressure-targeted' and 'volume-targeted' management strategies for optimizing cerebrovascular haemodynamics and specific interventions, such as hyperventilation, osmotherapy, cerebrospinal fluid drainage, barbiturates, decompressive craniectomy, therapeutic hypothermia, normobaric hyperoxia and hyperbaric oxygen therapy.

Methods: A review of the literature was performed to examine the evidence base behind each intervention.

Results: There is no class I evidence to support the routine use of any of the therapies examined.

Conclusion: Well-designed, large, randomized controlled trials are needed to determine therapies that are safe and effective from those that are ineffective or harmful.

Accepted for publication 31 August 2005.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1445-2197.2006.03674.x About DOI