Critical care management of head injury

The intensive care management of head injury requires a coordinated, comprehensive and multidisciplinary approach to treatment. Crucial to management is the prevention of secondary brain injury by avoidance of systemic physiological disturbances, such as hypotension and hypoxaemia, and maintenance of adequate cerebral perfusion and oxygenation. There have been marked improvements in the treatment of patients with severe traumatic brain injury over the last decade, leading to a reduction in both mortality and morbidity. Advances in management in the prehospital setting and in the A&E department have now been extended into the intensive care unit. The management of head injury has undergone extensive revision as evidence accumulates that established practices are not as effective or innocuous as previously believed. Management protocols have evolved with international consensus, providing guidelines that assist clinicians in delivering optimal care. Improved diagnostic and monitoring modalities are improving our understanding of the pathobiology of head injury and allowing the delivery of individualized therapeutic interventions.