Which treatments are safe and effective to reduce intracranial pressure following severe traumatic brain injury?

What you need to knowA tiered approach using multiple interventions to reduce raised intracranial pressure and maintain adequate cerebral perfusion pressure is reasonable in severe traumatic brain injuryThe effectiveness and safety of several common interventions is not known, because of a paucity of data from adequately powered, randomised controlled trialsUse your clinical judgment to balance the possible benefits and potential risks of treatments, and explore with patients and their loved ones what an acceptable outcome is, to guide decision makingForceful impact to the head can impair mental status and lead to neurobehavioural deficits. Most traumatic brain injuries (TBIs) are mild,1 but about 20% of patients have severe injury defined by a Glasgow coma scale (GCS) score ≤8 at presentation. Severe TBI has an incidence of 70 per 100 000 persons worldwide.23Multiple pathologies often combine to cause more harm than the initial head injury. Injuries may be focal or diffuse and…
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