Anaes · Neuroanaesthesia
Traumatic brain injury management and BTF targets
Also known as BTF guidelines · Severe TBI · Secondary brain injury · CRASH-3 · RESCUEicp
Fellowship management of severe TBI using Brain Trauma Foundation targets: ICP greater than 22, CPP 60–70, secondary injury prevention, osmotherapy, CRASH-3 TXA, and RESCUEicp decompression context.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Treat ICP greater than 22 mmHg; target CPP 60–70 mmHg (CPP = MAP − ICP).
- Avoid hypoxia and hypotension — dominant secondary insults.
- No corticosteroids for TBI outcome modification.
- Mannitol 0.25–1 g/kg or hypertonic saline for osmotherapy.
- TXA early (within 3 h) per CRASH-3 eligibility.
Meet the patient
A 24-year-old motorcyclist arrives by retrieval — GCS 6, blown left pupil, intubated and ventilated, MAP 65, SpO2 97 on FiO2 0.6. CT shows an acute subdural with 8 mm midline shift. The neurosurgeon is already scrubbing.[1]
The examiner's question lands before you reach theatre: "What are your targets, and what will you not give?" Every number from this point earns marks or loses them.[1]
References5ShowHide
- [1]Carney N et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition Neurosurgery, 2017.PMID 27654000
- [2]Hutchinson PJ et al. Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension N Engl J Med, 2016.PMID 27602507
- [3]CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial Lancet, 2019.PMID 31623894
- [4]Roberts I, Yates D, Sandercock P, et al. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial Lancet, 2004.PMID 15474134
- [5]Chesnut RM, Temkin N, Carney N, et al. A trial of intracranial-pressure monitoring in traumatic brain injury N Engl J Med, 2012.PMID 23234472