Abstract
Immediate early cerebral ischemia after traumatic brain injury (TBI) is common, and makes the brain further susceptible to secondary insults. Poor outcome is strongly associated with early cerebral ischemia. Global ischemia may reflect compromised cerebral perfusion pressure (CPP) because of systemic hypotension or increased intracranial pressure (ICP), and local ischemia may occur as a result of stagnation of microcirculation caused by inflammatory/hemostatic response immediately after trauma. Early reduction of cerebral blood flow (CBF) with deoxygenation after TBI is a therapeutic target. Accordingly, avoidance of hyperventilation, and CPP (CBF)-targeted management rather than ICP-targeted management would be recommended. Several guidelines for management of severe TBI have been published in recent years in the USA, Europe, and Japan. The availability of guidelines has led to significant improvements in the process and outcomes of care. However, only a few evidence-based standards or guidelines have been formulated. Even appropriate fluid balance or optimal CPP level has not yet been well defined. Further research is required to reduce the remaining uncertainties in the management of severe TBI, in which further targeting of therapy and evaluating its efficacy in specific situations is necessary.
