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Bart's Tips for successful TBI...part 2


Temperature mangement

  • Therapeutic hypothermia has shown great improvement in the cardiac arrest victims, however for the injured brain: “There is no evidence that hypothermia is beneficial in the treatment of head injury”.

  • Therapeutic hypothermia in the injured brain has resulted in more cases of coagulopathy, pneumonia and sepsis.


  • Bart’s recommend’s we should focus on “therapeutic normothermia” for these patient’s we know cooling is bad, but also fevers and hyperthermia is also detrimental as well.


  • We know fever increases cerebral metabolic rate and oxygen consumption with associated poor outcomes, however there is currently no good outcome studies to support this.



  • Take home point: fevers can develop quickly (yes even while the patient is still in ED), so monitor closely and treat aggressively.


    • Blood pressure

  • Patients with a severe brain injury often present with an abnormal blood pressure.


  • Hypotension is profoundly detrimental to these patient and needs to be treated aggressively to maintain cerebral perfusion pressure.


  • Hypertension can occur through the underlying physiological response to raised ICP, due to an underlying medical condition or may be related to pain and anxiety.


  • Treatment is generally not recommended in the hypertensive patient, remember these patients require sedatives and analgesia when intubated — providing this can relieve some of the hypertension.


  • On the rare occasion that you have to treat the high blood pressure, use short acting anti-hypertensive only and dose very gingerly

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