Physiologic targets for Traumatic Brain Injury in Neuro-Critical Care

Brandon Foreman takes you through physiological targets for traumatic brain injury in neuro-critical care. Intensivist and emergency medicine physicians already use physiology targets. They understand the complexity of these targets and the pitfalls of overreliance on any one parameter. This is also true for the use of physiology after traumatic brain injuries (TBI). TBI has never been defined by its physiology. In fact, specific targets of physiology to drive successful outcomes have all failed in the research in this patient group. It is no doubt a complex area. Physiology after traumatic brain injury is not simply defined on the pressure and volume in the skull. There are a huge variety of variables, including blood pressure, autoregulation and flow coupled functioning. Even with all these parameters, there is no Level 1 or 2A evidence for physiologic thresholding in TBI patients. As such, Brandon takes you through his approach to using physiology to manage TBI patients in neuro-critical care. He guides you through the approach, breaking up outcomes measures into three groups. First mechanics. Brandon will discuss blood pressure targets, and the real purpose of controlling them. Ultimately, he explains that thresholds are arbitrary and what is most important is blood flow. Secondly, Brendon considers metabolism. Here he guides you through the importance of glucose and ventilation with specific advice on parameters to use. Finally, he will take you through brain function, along with different clinical indicators that are useful when caring for a TBI patient in the neuro-critical care setting. This talk will encourage you to look at mechanics, metabolism, and brain function, considering each for the individual patient in front of you to guide best practice and deliver best outcomes.

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