Pre-ICU Management of Patients With Head Trauma

Abstract

Patients presenting with traumatic brain injury (TBI) pose special challenges for critical care personnel throughout the hospital, especially for emergency department and operating room personnel who care for TBI patients during their initial evaluation. Many of these patients proceed from the emergency department to an operating room for emergent cranial decompression en route to the ICU. At the authors’ hospital, a level I trauma center, steps have been taken to improve treatment in this pre-ICU care setting. In this report, the authors describe changes that have been made over time in the care of patients with TBI and the improved patient mortality that occurred after the introduction of these practice changes. The measures consisted of early goal-directed fluid resuscitation to correct intravascular volume depletion and vigilant hemodynamic monitoring by arterial line, central venous pressure, and transesophageal echocardiography. Despite these improved results, additional studies are needed to better define the best early treatment practices for the TBI patient.