Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy -
IRCCS Ospedale Policlinico San Martino, Genoa, Italy -
Minerva Anestesiol. 2021 Dec;87(12):1359-1366. doi: 10.23736/S0375-9393.21.15827-4. Epub 2021 Aug 2.
Refractory intracranial hypertension after traumatic brain injury (TBI) is defined as recurrent increase of intracranial pressure above 20-22 mmHg for sustained period of time (10-15 min), despite conventional therapies, such as osmotic therapy, cerebral spinal fluid drainage and mild hyperventilation. As such, more aggressive treatments should be taken into consideration. In particular, therapeutic hypothermia, barbiturates administration and decompressive craniectomy are considered as tier-three or "salvage" interventions, as they have shown to be able to control refractory hypertension; however, they are also associated with an increased risk of significant side effects. Therefore, the aim of this review was to describe the evidence supporting the use of these tier-three therapies in the management of refractory intracranial hypertension in TBI patients.
创伤性脑损伤（TBI）后难治性颅内高压定义为尽管采用了常规治疗方法，如渗透性治疗、脑脊髓液引流和轻度过度通气，但颅内压仍持续升高 20-22mmHg 以上一段时间（10-15 分钟）。因此，应该考虑采取更积极的治疗方法。特别是，治疗性低温、巴比妥酸盐给药和去骨瓣减压术被认为是三级或“挽救性”干预措施，因为它们已被证明能够控制难治性高血压；然而，它们也与发生重大副作用的风险增加相关。因此，本综述的目的是描述支持在 TBI 患者难治性颅内高压管理中使用这些三级治疗方法的证据。
