• Geert Meyfroidt, Pierre Bouzat, Michael P Casaer, Randall Chesnut, Sophie Rym Hamada, Raimund Helbok, Peter Hutchinson, MaasAndrew I RAIR0000-0003-1612-1264Department of Neurosurgery, University Hospital Antwerp, Edegem, Belgium., Geoffrey Manley, David K Menon, NewcombeVirginia F JVFJ0000-0001-6044-9035Department of Medicine, University Division of Anaesthesia, University of Cambridge, Cambridge, UK., Mauro Oddo, Chiara Robba, Lori Shutter, Martin Smith, Ewout W Steyerberg, Nino Stocchetti, Fabio Silvio Taccone, Lindsay Wilson, Elisa R Zanier, and Giuseppe Citerio.
• Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium. geert.meyfroidt@kuleuven.be.
• Intensive Care Med. 2022 Jun 1; 48 (6): 649666649-666.

AbstractTraumatic brain injury (TBI) remains one of the most fatal and debilitating conditions in the world. Current clinical management in severe TBI patients is mainly concerned with reducing secondary insults and optimizing the balance between substrate delivery and consumption. Over the past decades, multimodality monitoring has become more widely available, and clinical management protocols have been published that recommend potential interventions to correct pathophysiological derangements. Even while evidence from randomized clinical trials is still lacking for many of the recommended interventions, these protocols and algorithms can be useful to define a clear standard of therapy where novel interventions can be added or be compared to. Over the past decade, more attention has been paid to holistic management, in which hemodynamic, respiratory, inflammatory or coagulation disturbances are detected and treated accordingly. Considerable variability with regards to the trajectories of recovery exists. Even while most of the recovery occurs in the first months after TBI, substantial changes may still occur in a later phase. Neuroprognostication is challenging in these patients, where a risk of self-fulfilling prophecies is a matter of concern. The present article provides a comprehensive and practical review of the current best practice in clinical management and long-term outcomes of moderate to severe TBI in adult patients admitted to the intensive care unit.© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.

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