Publication: Management of severe traumatic brain injury (first 24 hours)

About

The latest French Guidelines for the management in the first 24 hours of patients with severe traumatic brain injury (TBI) were published in 1998. Due to recent changes (intracerebral monitoring, cerebral perfusion pressure management, treatment of raised intracranial pressure), an update was required. Our objective has been to specify the significant developments since 1998. These guidelines were developed by a group of experts for the French Society of Anesthesia and Intensive Care Medicine (Société francaise d'anatomie et de réanimation [SFAR]) in partnership with the French-Speaking Association of Neuro-Anesthesia and Intensive Care (ANARLF), the French Society of Emergency Medicine (Société française de médecine d'urgence [SFMU]), the French Society of Neurosurgery (SFN), the French-Speaking Group for Pediatric Intensive Care and Emergency Medicine (GFRUP), and the Association of French-Speaking Pediatric Anesthesiologists and Intensive Care Physicians (ADARPEF). The method used to develop these guidelines was the Grade® method. After two Delphi rounds, 32 recommendations were formally developed by the experts, focusing on the evaluation of the initial severity of traumatic brain injury, prehospital management, imaging strategies, indications for neurosurgical interventions, sedation and analgesia, indications and methods of cerebral monitoring, and medical management of elevated intracranial pressure. pressure, management of multiple trauma with severe traumatic brain injury, detection and prevention of post-traumatic epilepsy, biological homeostasis (osmolarity, glycaemia, adrenal axis) and pediatric specificities.