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Minerva Anestesiologica 2021 December;87(12):1359-66

DOI: 10.23736/S0375-9393.21.15827-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Tier-three therapies for refractory intracranial hypertension in adult head trauma

Chiara ROBBA ^{1, 2} ✉, Francesca IANNUZZI ¹, Fabio S. TACCONE ³

¹ Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; ² IRCCS Ospedale Policlinico San Martino, Genoa, Italy; ³ Department of Intensive Care Medicine, Erasme Hospital, University of Brussels, Brussels, Belgium

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.

KEY WORDS: Brain injuries, traumatic; Barbiturates; Decompressive craniectomy; Hypothermia