Stocker Reto A
Institute for Anesthesiology and Intensive Care Medicine, Klinik Hirslanden, CH-8032 Zurich, Switzerland.
Med Sci (Basel). 2019 Feb 26;7(3):37. doi: 10.3390/medsci7030037.
Moderate to severe traumatic brain injuries (TBI) require treatment in an intensive care unit (ICU) in close collaboration of a multidisciplinary team consisting of different medical specialists such as intensivists, neurosurgeons, neurologists, as well as ICU nurses, physiotherapists, and ergo-/logotherapists. Major goals include all measurements to prevent secondary brain injury due to secondary brain insults and to optimize frame conditions for recovery and early rehabilitation. The distinction between moderate and severe is frequently done based on the Glascow Coma Scale and therefore often is just a snapshot at the early time of assessment. Due to its pathophysiological pathways, an initially as moderate classified TBI may need the same sophisticated surveillance, monitoring, and treatment as a severe form or might even progress to a severe and difficult to treat affection. As traumatic brain injury is rather a syndrome comprising a range of different affections to the brain and as, e.g., age-related comorbidities and treatments additionally may have a great impact, individual and tailored treatment approaches based on monitoring and findings in imaging and respecting pre-injury comorbidities and their therapies are warranted.
中重度创伤性脑损伤（TBI）需要在重症监护病房（ICU）进行治疗，由多学科团队密切协作，该团队包括不同的医学专家，如重症医学专家、神经外科医生、神经内科医生，以及ICU护士、物理治疗师和职业/言语治疗师。主要目标包括采取一切措施预防因继发性脑损伤导致的二次脑损伤，并优化恢复和早期康复的条件。中重度的区分通常基于格拉斯哥昏迷量表，因此往往只是评估早期的一个快照。由于其病理生理途径，最初被归类为中度的TBI可能需要与重度TBI相同的精密监测、监控和治疗，甚至可能进展为严重且难以治疗的病症。由于创伤性脑损伤是一种包含一系列不同脑部病症的综合征，并且例如与年龄相关的合并症和治疗方法可能会产生重大影响，因此有必要基于影像学监测和检查结果，针对个体情况制定个性化的治疗方案，并考虑伤前合并症及其治疗方法。
