Wednesday, August 21, 2019

Resuscitation Pressure in Polytrauma with TBI

Taming The SRU - August 19, 2019 - By Rath K., Gottula A
  • There is little data to help us in optimal blood pressure targets in patients with both TBI and systemic trauma with hemorrhagic shock, largely because these patients are excluded from the majority of studies. Given the significant evidence that permissive hypotension would be associated with worse TBI related outcomes, we would not recommend prehospital permissive hypotension in the subset of patients with blunt, severe TBI.
  • In the resuscitation of these patients, hypertonic saline offers great promise as a means to resuscitate patients in hemorrhagic shock, while also minimizing intracranial pressure. Mannitol is a less than ideal alternative until more definitive data is obtained on injuries, and the patient is hemodynamically stabilized.
  • Future directions on this topic should include high-quality, high-powered studies investigating the hypotensive strategies to include patients with severe traumatic brain injury with GCS 8 or lower.
  • Finally, a good neurologic exam to more sensitively assess for focal neurologic deficits and signs of intracranial hypertension can assist pre-hospital providers to better determine the likelihood of the presence or absence of traumatic brain injury."