Thresholds

 

  • BP

    • ↓ SBP associated with worse outcomes

    • Recommendations:

      • Consider maintaining SBP ≥100 mmHg for pts 50-69 yrs or ≥110 mmHg for pts 15-49 or >70 yrs (↓ mortality, improve outcomes)

  • ICP

    • Recommendations:

      • Treat ICP >22 mmHg; higher levels a/w ↑ mortality

      • Combo of ICP values & brain CT findings may be used to make mgt decisions

  • CPP

    • CPP = MAP – ICP

    • Recommendations:

      • Target CPP between 60 & 70 mmHg for survival & favourable outcomes

      • Avoid aggressive attempts to maintain CPP >70 mmHg w/ fluids/pressors (↑ risk ARDS)

  • Advanced cerebral monitoring

    • Goal of medical mgt of severe TBI = ensure optimal nutrient delivery to brain through period of abnl physiology & brain swelling following injury

    • Recommendations:

      • Jugular venous sat <50% may be a threshold to avoid (↓ mortality, improve outcomes)

 

 

Adapted from Guidelines for the Management of Severe TBI, 4th Ed., September 2016, Brain Trauma Foundation.