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Minerva Anestesiologica 2021 Aug 02

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 San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy; 3 Department of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium


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Refractory intracranial hypertension after traumatic brain injury (TBI) is defined as recurrent increase of intracranial pressure (ICP) 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, but are also associated with an increased risk of significant side effects. The aim of this review is therefore to describe the evidence supporting the use of these tier-three therapies in the management of refractory intracranial hypertension in TBI patients.


KEY WORDS: Refractory intracranial hypertension; Traumatic brain injury; Tier three therapies; Barbiturates; Decompressive craniectomy; Hypothermia

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