SEVERE BRAIN INJURY - PART II - THERAPY

Part I of this two-part presentation established that secondary brain injury results from increased neuronal and cerebrovascular sensitivity , increased intracranial pressure, and episodes of systemic hypotensio n and hypoxemia. Based on this information, treatment of head injury h as been reevaluated. Diuretics and hyperventilation are now considered potentially deleterious because they limit necessary blood flow and o xygen delivery to cerebral tissue. Maintenance of euvolemia, cerebral perfusion, oxygenation, and other normal metabolic and physiologic par ameters are now recommended treatment measures that can reduce the ris k of secondary brain injury after the initial trauma has been addresse d. In particular, physiologic monitoring represents the clinician's be st defense in preventing secondary brain injury.