Arquivos de neuro-psiquiatria
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A comprehensive review is presented on current international trends regarding research and management of severe acute brain trauma. Controversial issues are thoroughly discussed and an attempt is made to clarify questionable aspects from pertinent publications in the international literature. A proposition is made to manage not only intracranial pressure and perfusion pressure, but also cerebral hemometabolic parameters in these critically ill patients. Currently available management guidelines are not evidence-based.
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A critical evaluation was done about the guidelines and effects of the hyperventilation maneuver on prevention and treatment of increased intracranial pressure (ICP) that follows severe traumatic brain injury (TBI). The prophylactic use of hyperventilation should be avoided after severe TBI acute phase, unless high venous O2 values are recorded at jugular bulb blood (SjO2), or to allow time when there are evidences of neurologic deterioration with posturing. ⋯ Then, hyperventilation may be used as a screening therapeutic test in acute severe TBI, since BBB impairment is the pointer that other available clinical procedures for high ICP control (sedation, paralysis and osmotic diuretics) are not workable. A new pathogenetic hypothesis about traumatic brain edema and its therapeutic approach is presented.