A Modern Approach to the Treatment of Traumatic Brain Injury
Abstract
:1. Introduction
2. Concepts and Strategies for TBI Therapy
3. Secondary Brain Injury in TBI
4. Emergency Care for TBI
4.1. Head Position
4.2. Airway Management
4.2.1. Tracheostomy
4.2.2. Hyperventilation
4.2.3. Ventilator-Associated Pneumonia
4.3. Prevention of Seizures
4.4. Sedation and Induced Coma
- Administration of barbiturates to suppress seizures and as a prophylaxis for intracranial hypertension is not recommended (grade IIB).
- High doses of barbiturates are recommended to control intracranial pressure refractory to maximum standard surgical and medical treatments while maintaining hemodynamic stability.
- Although propofol can be used to control intracranial pressure, it is not recommended for reducing mortality or six-month outcomes.
4.5. Hypothermia
4.6. Blood Pressure and Cerebral Perfusion Pressure (CPP)
- To reduce mortality and improve the outcomes (level III), maintain SBP at ≥100 mm Hg for patients aged 50 to 69 years or at a level ≥110 mm Hg or higher for patients aged 15 to 49 or older than 70.
- The recommended CPP target for survival and good outcomes is 60 to 70 mm Hg. The optimal CPP may depend on the patient’s autoregulatory status (level IIB).
- Aggressive attempts to maintain CPP above 70 mm Hg with fluids and vasopressors should be avoided.
4.7. Fluid Management
4.8. Tranexamic Acid
5. Surgical Interventions for TBI
6. Pharmacological Therapy of TBI
6.1. Corticosteroids
6.2. Progesterone
6.3. Erythropoietin
6.4. Amantadine
6.5. N-Acetylcysteine
6.6. Minocycline
6.7. Phenserine
6.8. Calcium Channel Blockers
6.9. Antioxidants
6.10. Beta-Blockers
6.11. Metformin
6.12. Cerebrolysin
6.13. Vitamin D
7. Regenerative Treatment
7.1. Neurotrophic Factors
7.2. Suppression of RhoA GTPase
7.3. DNA Vaccine
7.4. Protein S100B
7.5. Overcoming the Glial Scar
7.6. Stem Cell Therapy
7.7. Nanoparticles
8. Treatment Based on Physical Principles
8.1. Hyperbaric Oxygen Therapy (HBOT)
8.2. Non-Invasive Brain Stimulation
9. Complementary Medicine
10. Mild TBI Management
11. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Strategies of TBI Management | Specific Methods of TBI Treatment |
---|---|
Emergency care of TBI | Head position Airway management Tracheostomy Hyperventilation Ventilator-associated pneumonia Prevention of seizures Sedation and induced coma Hypothermia Blood pressure and cerebral perfusion pressure Fluid management Tranexamic acid |
Surgical interventions for TBI | Decompressive craniectomy Kempe hemispherectomy incision Cisternostomy |
Pharmacological therapy of TBI | Corticosteroids Progesterone Erythropoietin Amantadine N-acetylcysteine Minocycline Phenserine Calcium channel blockers Antioxidants Beta-blockers Metformin Cerebrolysin Vitamin D |
Regenerative treatments | Neurotrophic factors Suppression of RhoA GTPase DNA vaccine Protein S100B Overcoming the glial scar Stem cell therapy Nanoparticles |
Treatment based on physical principles | Hyperbaric oxygen therapy Non-invasive brain stimulation |
Complementary therapy | Phytotherapy Acupuncture |
Mild TBI management |
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Syzdykbayev, M.; Kazymov, M.; Aubakirov, M.; Kurmangazina, A.; Kairkhanov, E.; Kazangapov, R.; Bryzhakhina, Z.; Imangazinova, S.; Sheinin, A. A Modern Approach to the Treatment of Traumatic Brain Injury. Medicines 2024, 11, 10. https://doi.org/10.3390/medicines11050010
Syzdykbayev M, Kazymov M, Aubakirov M, Kurmangazina A, Kairkhanov E, Kazangapov R, Bryzhakhina Z, Imangazinova S, Sheinin A. A Modern Approach to the Treatment of Traumatic Brain Injury. Medicines. 2024; 11(5):10. https://doi.org/10.3390/medicines11050010
Chicago/Turabian StyleSyzdykbayev, Marat, Maksut Kazymov, Marat Aubakirov, Aigul Kurmangazina, Ernar Kairkhanov, Rustem Kazangapov, Zhanna Bryzhakhina, Saule Imangazinova, and Anton Sheinin. 2024. "A Modern Approach to the Treatment of Traumatic Brain Injury" Medicines 11, no. 5: 10. https://doi.org/10.3390/medicines11050010