Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review

Figures

• 

  Figure 1. Intracranial pressure monitor-based management algorithm for severe traumatic brain injury patients (modified from Hawryluk GWJ et al. [57]). ICU, intensive care unit; CVD, cerebral venous drainage; EtCO2, end tidal carbon dioxide; SpO2, arterial oxygen saturation; ABP, arterial blood pressure; CPP, cerebral perfusion pressure, PaCO2, arterial partial pressure of carbon dioxide; CSF, cerebral spinal fluid; EVD, external ventricular drain; EEG, electroencephalogram; NMBA, neuromuscular blocking agent; MAP, mean arterial pressure; ICP, intracranial pressure; CT, computed tomography; IH, Intracranial hypertension.

• 

  Figure 2. Summary of the World Society of Emergency Surgery consensus conference recommendations, regarding the monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 h (modified from Picetti et al. [32]). (1) Coma plus radiological signs of IH. (2) Temporarily lower values in case of difficult bleeding control. (3) Higher threshold in patients at “risk” (e.g., elderly, pre-existing heart disease, etc.). (4) Higher values for emergency neurosurgery (including ICP probe insertion). (5) Later on, the ratio may be modified according to laboratory values. (6) This value can be personalized considering neuromonitoring data and cerebral autoregulation status. (7) If impossible to target the underling pathophysiology of IH.

• 

  Figure 3. Suggested monitoring for severe TBI patients with polytrauma undergoing surgery. TBI, traumatic brain injury; DCS, damage control surgery; ETCO2, end-tidal carbon dioxide; SpO2, peripheral oxygen saturation; ECG, electrocardiogram; ABP, arterial blood pressure; ICP, intracranial pressure; CPP, cerebral perfusion pressure; SMS simultaneous multisystem surgery.