Management of Severe Traumatic Brain Injury

Terje Sundstrom, MD, PhD, is a senior consultant neurosurgeon at Haukeland University Hospital and an associate professor at the University of Bergen in Norway. He was editor-in-chief of the first edition of Management of severe traumatic brain injury (2012). He also has a strong interest in translational and clinical research on benign and malignant brain tumors. Per-Olof Grande, MD, PhD, is senior professor in anaesthesia and intensive care at Lund University Hospital in Sweden. His research is concentrated on basal circulatory physiology with special application to neurointensive care and the traumatized brain. Teemu Luoto, MD, PhD, is a neurosurgeon at the Tampere University Hospital and an adjunct professor in neurotraumatology at the University of Tampere in Finland. His clinically oriented research is focused on traumatic brain injury, especially mild traumatic brain injury and sport-related concussion, and traumatic spinal cord injury. Christina Rosenlund, MD, MHO, is a senior consultant neurosurgeon at Odense University Hospital in Denmark and affiliated with the Danish Center for Organdonation. Her clinically oriented research is focused on traumatic brain injury, neurointensive care, rehabilitation and organdonation. Johan Unden, MD, PhD, DESA, EDIC, is a senior consultant at the intensive care unit at Hallands Hospital and an associate professor in anesthesia and intensive care at Lund University Hospital in Sweden. His research is concentrated in the area of neurotrauma, in particular mild traumatic brain injury, and also in neuroprotection and clinical coagulation. Knut Gustav Wester, MD, PhD is a professor emeritus from the University of Bergen and was previously head of the neurosurgical department at Haukeland University Hospital in Norway. He is a founding member of the Scandinavian Neurotrauma Committee and president of the committee since 2013. His clinically oriented research has included several aspects of traumatic brain injury.

Introduction.- Part I Traumatic brain injury as a public health problem.- Epidemiological aspects.- Challenges in low- and middle income countries.- Challenges in the elderly.- Challenges in children.- Biomechanics and prevention.- Part II Classification and assessment.- Pathophysiology of severe traumatic brain injury.- Classification of head injury.- Primary clinical assessment.- Part III Prehospital management.- Prehospital guidelines.- What the neurosurgeon and the trauma team want to know: what, who, when, and where?.- Transportation.- Part IV Admission, diagnostics and planning.- The trauma team concept.- Trauma protocol (ABCDE).- Hospital response to mass casualty incidents.- Cervical spine injury.- Blast-induced injury.- Radiological evaluation of head trauma.- Radiological evaluation of cervical spine trauma.- Blood samples.- To treat or not to treat in the acute setting (withholding) and withdrawal of treatment.- Potential organ donor: organ donor management.- Ethical aspects and communication.- Part V Acute surgical treatment.- Basic trauma craniotomy.- Surgical management of traumatic intracranial haematomas.- Surgical management of penetrating brain injuries.- Decompressive craniectomy.- Skull fractures.- Vessel injuries.- Insertion of intracranial monitoring devices.- Maxillofacial fractures.- Considerations in patients with concomitant cervical spine injuries.- Soft tissue injuries.- Surgery outside neurosurgical units.- Planning of cranial and extracranial surgery in multitraumatised patients.- Part VI Perioperative anaesthesia.- Choice of anaesthesia, drugs and medications.- Blood pressure, CO2 and oxygen saturation.- Intracranial pressure reduction.- Part VII Monitoring in neurointensive care

Secondary clinical assessment.- A wake-up test in the neurointensive care management of patients with severe TBI: pros and cons.- Intracranial pressure (ICP):Theoretical and practical aspects.- Brain tissue oxygen monitoring.- Monitoring microdialysis.- Jugular bulb measurements (SJVO2).- Cerebral blood flow (CBF) and cerebral metabolic rate (CMR).- Transcranial Doppler (TCD).- Near infrared spectroscopy (NIRS) or cerebral oximetry.- Clinical Neurophysiology: Evoked Potentials.- Clinical Neurophysiology: Continous EEG Monitoring.- Imaging of severe traumatic brain injury in the neurointensive care unit.- Serum protein biomarkers in the management of severe traumatic brain injury.- Cardiopulmonary aspects.- Renal aspects.- Neuroendocrine aspects.- Part VIII Treatment in neurointensive care.- Guidelines for treatment of patients with severe traumatic brain injury.- The Lund therapy: a physiological approach.- Pharmacological neuroprotection.- Subacute surgery in neurointensive care.- Management of extracranial injuries.- CSF Drainage.- Hyperventilation.- Osmotherapy.- Barbiturates for ICP management.- Management of fluid and electrolyte disturbances.- Sedation: including pain treatment and withdrawal symptoms.- Nutrition.- Managementof CNS-related infection.- Management of extracranial infections.- Temperature management.- Seizures.- Paroxysmal sympathetic hyperactivity.- Prophylaxis against venous thromboembolism.- Coagulopathy (bleeding tendency).- Corticosteroids.- Management of acute psychiatric problems.- Part IX Rehabilitation and follow-up.- Rehabilitation after severe TBI.- Long-term follow-up.- Part X Outcome and prognosis.- General overview.- Somatic consequences.- Neuropsychiatric consequences.- Neuropsychological perspectives.- Neurosurgical challenges.- Minimally conscious and vegetative state.- Specific peadiatric concerns.- Socioeconomic consequences.- Subacute MR Imaging: Traumatic axonal injury, brain stem lesions and prognostic factors.- Neurodegeneration and dementia.- Part XI Research in severe TBI.- The neurointensive care unit as a platform for advanced clinical research.- Current state-of-the-art in neurotrauma research.- Index.