Russo Larissa, Kazmi Aasim, Ahmed Nasim
Department of Surgery, Division of Trauma, Jersey Shore University Medical Center, Neptune, NJ 07753, USA.
Department of Neurosurgery, Jersey Shore University Medical Center, Neptune, NJ 07753, USA.
Medicina (Kaunas). 2025 Apr 17;61(4):738. doi: 10.3390/medicina61040738.
: Severe Traumatic Brain Injury (TBI) is one of the devastating injuries occurring in all ages across the globe. Despite many advancements in the management of severe TBI, mortality and morbidities remain high. Evidence-based management in severe TBI has reduced mortality. The purpose of this review is to discuss the current management and present the future challenges in this patient cohort. : A literature review was conducted to identify the current practice patterns and guidelines of severe TBI. We examined the literature regarding medical and surgical managements of the severe TBI. : Initial management of severe TBI includes stabilization of the primary injury and prevention of secondary insult to brain. Hemodynamic, intracranial pressure and cerebral perfusion pressure monitoring, antiseizure prophylaxis, hyperosmolar therapy, sedation, medical induced coma, and nutritional and ventilatory support are part of the medical management. Operative intervention includes craniotomy and decompressive craniectomy. Most of the current practices are recommended by the Brain Trauma Foundation (BTF). These guidelines are based on the existing literature, however, some of the recommendations by the BTF lack level one evidence. : BTF guidelines provide recommendations in the management of severe TBI. High quality prospective randomized trials are needed to further explore the new modalities and interventions in the field of severe TBI.
重度创伤性脑损伤（TBI）是全球各年龄段均会发生的毁灭性损伤之一。尽管在重度TBI的治疗方面取得了许多进展，但死亡率和发病率仍然很高。重度TBI的循证治疗已降低了死亡率。本综述的目的是讨论当前的治疗方法，并提出该患者群体未来面临的挑战。
进行了一项文献综述，以确定重度TBI的当前实践模式和指南。我们研究了有关重度TBI药物和手术治疗的文献。
重度TBI的初始治疗包括稳定原发性损伤和预防对大脑的二次损伤。血流动力学、颅内压和脑灌注压监测、抗癫痫预防、高渗疗法、镇静、药物诱导昏迷以及营养和通气支持都是药物治疗的一部分。手术干预包括开颅手术和减压性颅骨切除术。目前的大多数做法是由脑创伤基金会（BTF）推荐的。这些指南基于现有文献，然而，BTF的一些建议缺乏一级证据。
BTF指南为重度TBI的治疗提供了建议。需要高质量的前瞻性随机试验来进一步探索重度TBI领域的新方法和干预措施。
