Therapy for TBI in multiply injured patients is directed toward minimizing secondary brain injury by optimizing cerebral perfusion pressure and cerebral blood flow.
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Guides TBI management in polytrauma to limit secondary injury via CPP and CBF optimization; leaves open optimal targets and monitoring integration for prospective trials.
Traumatic brain injury (TBI) in the multiply injured patient can be challenging to manage for trauma surgeons, neurosurgeons, and anesthesiologists due to the competing priorities of the diagnostic workup and treatment ofbrain injuries versus systemic injuries. TBI is the leading cause of death in trauma victims, accounting for approximately half of all trauma-related deaths. 1 Destruction of brain tissue occurs in two phases: the primary injury, which involves direct tissue damage at the time of the inciting event, and the subsequent secondary injury, which occurs due to ischemia, causing calcium ion influx and free radical accumulation. Primary injury is considered irreversible, and therefore therapy is directed toward minimizing the secondary brain injury by optimizing cerebral perfusion pressure (CPP) and cerebral blood flow (CBF) and by aggressive treatment of intracranial hypertension.
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Lee et al. (2002) studied this question.
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