Traumatic Brain Injury

Severe Traumatic Brain Injury

Severe TBI is not a single lesion or merely an ICP problem. The first hours require simultaneous prevention of secondary physiologic injury while rapidly identifying expanding hemorrhage, inadequate oxygen delivery, impaired cerebral perfusion, and lesions requiring surgical source control.

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Severe TBI: ICU Management

Severe-TBI ICU care is a cycle of mechanism identification, targeted intervention, and physiologic reassessment—not automatic progression through an ICP ladder. Sedation, CSF drainage, osmotherapy, ventilation, CPP manipulation, and tier-three rescue may lower ICP while creating competing systemic or neurologic injury.

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TBI Neuroprognostication Challenges

Neuroprognostication after severe TBI is a longitudinal, probabilistic process—not a verdict from one examination, scan, or calculator. Serial standardized assessment, multimodal phenotyping, explicit time horizons, and honest communication of uncertainty help prevent an early severity signal from being mistaken for irreversible outcome.

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Paroxysmal Sympathetic Hyperactivity After Severe TBI

PSH is a positive longitudinal syndrome defined by recurrent, simultaneous sympathetic and motor activation, often triggered by routine stimulation. Bedside care depends on excluding dangerous mimics, separating episode abortion from prevention, and controlling consequential episodes without sacrificing cerebral perfusion, arousal, mobility, or rehabilitation.

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Joshua Lukas, MD (Instagram: @Neurointensivist)

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