Overview
Acute brain injury (ABI) encompasses traumatic brain injury, stroke, and other conditions leading to neurological dysfunction, often necessitating intensive care management to address both neurological and systemic complications.Diagnosis
Neurological assessment including Glasgow Coma Scale (GCS) scoring 4.
Imaging studies (CT, MRI) to identify structural damage 14.
Monitoring of intracranial pressure (ICP) in severe cases 3.
Evaluation for systemic complications indicative of neurogenic organ dysfunction syndrome (NODS) 2.Management
First-line treatments:
- Early goal-directed therapy tailored to ICP and cerebral perfusion pressure 3.
- Mechanical ventilation with careful sedation management to minimize deep sedation 5.
Adjunctive treatments:
- Liberal transfusion strategy to improve outcomes 1.
- Prophylactic ceftriaxone to reduce early ventilator-associated pneumonia (VAP) risk in mechanically ventilated patients 4.
- Targeted temperature management and seizure control as indicated 5.Special Populations
Pediatrics: Not specifically addressed in provided abstracts.
Elderly: Not specifically addressed in provided abstracts.
Comorbidities: Management considerations for comorbidities like cardiovascular instability are crucial, especially in the context of NODS 2.Key Recommendations
Implement a liberal transfusion strategy to enhance outcomes in patients with acute brain injury (Evidence: Strong 1).
Optimize sedation practices, favoring daily interruption and minimizing deep sedation to improve neurological outcomes (Evidence: Moderate 5).
Consider prophylactic ceftriaxone for reducing the incidence of early ventilator-associated pneumonia in mechanically ventilated patients with severe brain injury (Evidence: Moderate 4).
Vigilantly monitor for and manage neurogenic organ dysfunction syndrome (NODS) to mitigate systemic complications (Evidence: Expert opinion 2).
Employ advanced neurological monitoring techniques, including ICP monitoring, in critically ill ABI patients supported by ECMO (Evidence: Expert opinion 3).References
1 Rosenberg K. Better outcomes with liberal transfusion strategy in patients with acute brain injury. The American journal of nursing 2025. link
2 Zhang H, Chen WJ, Chao YG, Su N, Robba C, Czosnyka M et al.. Neurogenic organ dysfunction syndrome after acute brain injury. Military Medical Research 2025. link
3 Cho SM, Hwang J, Chiarini G, Amer M, Antonini MV, Barrett N et al.. Neurological Monitoring and Management for Adult Extracorporeal Membrane Oxygenation Patients: Extracorporeal Life Support Organization Consensus Guidelines. ASAIO journal (American Society for Artificial Internal Organs : 1992) 2024. link
4 Dahyot-Fizelier C, Lasocki S, Kerforne T, Perrigault PF, Geeraerts T, Asehnoune K et al.. Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial. The Lancet. Respiratory medicine 2024. link00471-X)
5 Oddo M, Crippa IA, Mehta S, Menon D, Payen JF, Taccone FS et al.. Optimizing sedation in patients with acute brain injury. Critical care (London, England) 2016. link
6 Berthiaume L, Zygun D. Non-neurologic organ dysfunction in acute brain injury. Critical care clinics 2006. link