Treating Intracranial Hypertension in Patients with Severe Traumatic Brain Injury during Neurointensive Care

摘要

Despite the envisioned breakthrough prophesied for\udthe end of the past century in healing brain injured patients,\udboth clinicians and basic scientists are still struggling\udwith this burden. In the past decades, intensive\udresearch has brought forward a plethora of different\udtargets which – in part – have already been integrated\udin clinical routine directed at detailed monitoring, therapeutic\udinterventions, and prevention of secondary deterioration.\udWhile intracellular targets remain obscure\udalterations on a larger scale as e.g., measured intracranial\udpressure (ICP), calculated cerebral perfusion pressure\ud(CPP), and various imaging techniques are fundamental\udcomponents of our present clinical\udunderstanding. At bedside, comprehension of pathophysiological\udloops and circuits of a given value (e.g.,\udICP) depends on individual knowledge, interpretation,\udand availability of additional diagnostic steps. As stated\udin the guidelines brought forward by the American Association\udof Neurological Surgeons and evaluated in\udvarious reports by the Cochrane Library we are still lacking\udprospective, randomized trials for the majority of\udthe proposed diagnostic and therapeutic interventions.\udIn this context, a recent meta-analysis even questioned\udthe importance of ICP monitoring as we are lacking data\udfrom randomized controlled trials clarifying the role\udof ICP monitoring. The present review is to give an overview\udof various diagnostic and therapeutic possibilities\udbased on reports published in the past 5 years to\udstrengthen current approaches and nourish future\udwell-designed investigations how to avoid and treat intracranial\udhypertension.