Neuroprotection in traumatic brain injury: practical implications for Papua New Guinea and some research developments.

Given the lack of infrastructure in Papua New Guinea (PNG) traumatic brain injury (TBI) cases are usually not retrieved quickly to medical centres. Cases that eventually reach the hospital do so after the golden hour has passed. This means that the brain is already at risk of or is already subject to secondary brain injury. In TBI, the parenchymal integrity of the normal, the penumbrous and the lacerated tissue needs to be kept in a state of balance, such that the normal tissue is not compromised. The whole aim of neuroprotection is to protect the normal brain parenchyma from further injury. Secondary brain injury is minimized by reducing cerebral oedema and intracranial pressure, in order to improve cerebral blood flow and perfusion. This guideline describes the options for neuroprotection in PNG.