With the recent publication of the new BTF guidelines (at bloody last) the topic of severe brain injury becomes more likely to appear in the fellowship exam. The aim of this page is to have a list of the BTF directives collected in one spot to allow rapid revision. Wherever possible, the normal urge to explore to the nth degree of fine detail has been suppressed in favour of brevity.
The links to the specific guideline statement are available below (the bold headings). If one wishes to examine the evidence in greater detail, one is invited to explore the original 244 page document.
"Prophylactic" hypothermia (early, to prevent secondary brain injury)
Systolic blood pressure target:
Our beloved Oh's Intensive Care manual has two excellent chapters to dedicate to this topic:
Chapter 43 (pp. 563) Cerebral protection by Victoria Heaviside and Michelle Hayes, and
Chapter 67 (pp. 765) Severe head injury by John A Myburgh.
The only reference really needed for this are the excellent Brain Trauma Foundation Guidelines.
Sydenham, Emma, Ian Roberts, and Phil Alderson. "Hypothermia for traumatic head injury." Cochrane Database Syst Rev 2 (2009).
Herregods, L., et al. "Effect of propofol on elevated intracranial pressure. Preliminary results." Anaesthesia 43.s1 (1988): 107-109.
Trochut, E., et al. "Cerebral hemodynamic and metabolic effects of propofol or thiopental in the treatment of refractory intracranial hypertension in patients with severe traumatic brain injury: A preliminary study: 7AP2‐10." European Journal of Anaesthesiology (EJA) 28 (2011): 101.
D'Hollander, S., et al. "Retrospective analysis of the hemodynamic effects of induction of barbiturate coma in patients with refractory elevated intracranial pressure." Critical Care 17.Suppl 2 (2013): P330.
Roberts, I., and E. Sydenham. "Barbiturate drugs for people with traumatic brain injury." Health (2012).
Selman, Warren R., et al. "Barbiturate-induced coma therapy for focal cerebral ischemia: Effect after temporary and permanent MCA occlusion." Journal of neurosurgery 55.2 (1981): 220-226.
Eisenberg, Howard M., et al. "High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury." Journal of neurosurgery 69.1 (1988): 15-23.
de Nadal, Miriam, et al. "Cerebral hemodynamic effects of morphine and fentanyl in patients with severe head injury: absence of correlation to cerebral autoregulation." Anesthesiology 92.1 (2000): 11.
Roberts, Derek J., et al. "Sedation for critically ill adults with severe traumatic brain injury: A systematic review of randomized controlled trials*." Critical care medicine 39.12 (2011): 2743-2751.
Cooper, D. James, et al. "Decompressive craniectomy in diffuse traumatic brain injury." New England Journal of Medicine 364.16 (2011): 1493-1502.
Edwards, P., et al. "Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months." Lancet 365.9475 (2004): 1957-1959.
Himwich, Williamina A., et al. "Brain metabolism in man: unanesthetized and in pentothal narcosis." American Journal of Psychiatry 103.5 (1947): 689-696.
Backhaus, Samantha. "Secondary Brain Injury." Encyclopedia of Clinical Neuropsychology. Springer New York, 2011. 2220-2221.
Siesjö, B. K., and P. Siesjö. "Mechanisms of secondary brain injury." European journal of anaesthesiology 13.3 (1996): 247-268.
Doberstein, Curtis E., David A. Hovda, and Donald P. Becker. "Clinical considerations in the reduction of secondary brain injury." Annals of emergency medicine 22.6 (1993): 993-997.
Ghajar, Jamshid. "Traumatic brain injury." The Lancet 356.9233 (2000): 923-929.
Hawryluk, Gregory WJ, et al. "Guidelines for the management of severe traumatic brain injury: 2020 update of the decompressive craniectomy recommendations." Neurosurgery 87.3 (2020): 427-434.