SOFT PACK IN TRAUMATIC BRAIN INJURY: A LITERATURE REVIEW(Atena Editora)

Abstract

INTRODUCTION: Traumatic Brain Injury (TBI) is a complex neurological disorder resulting from external mechanical forces applied to the head, encompassing a spectrum of injury severity from mild concussions to severe cases with prolonged loss of consciousness and extensive neurological deficits. The pathophysiology involves both primary injuries, occurring at the moment of impact, and secondary injuries, involving biochemical and cellular processes evolving over time. Intracranial hypertension (ICH) is characterized by increased pressure within the cranial cavity, resulting from pathological mechanisms like CSF accumulation, cerebral edema, or mass lesions OBJETIVE: To Analyze and describe the main aspects of TBI and its treatment in the last years. METHODS: This is a narrative review. The base dates used were PubMed, sciELO and Medline, using as descriptors: “Traumatic Brain Injury” AND “Intracranial hypertention” AND “Trauma” AND “axonal injury” AND “treatment”. Only studies writing in inglish and were included. RESULTS AND DISCUSSION: The text delves into various aspects of TBI management, focusing on critical considerations such as intracranial pressure (ICP), physiological parameters maintenance, and therapeutic interventions. ICP, representing the balance within the skull, is pivotal for cerebral perfusion, and elevated ICP during TBI can compromise blood flow, leading to ischemia and exacerbating the initial injury. Monitoring and managing ICP, including maintaining it below 20 mmHg, are crucial in TBI care, with interventions like head elevation, osmotic therapy, and surgical procedures. The comprehensive management involves ensuring optimal physiological parameters, including oxygen saturation, blood pressure, and normocapnia, as deviations can impact cerebral blood flow and exacerbate intracranial hypertension. The text emphasizes the significance of maintaining the head in an elevated position to mitigate ICP, the importance of fever control, and the correction of coagulation disorders to prevent hemorrhagic complications. Furthermore, therapeutic interventions like hypertonic saline 3%, mannitol, sedation, and neuromuscular blockade are discussed in the context of TBI management. These interventions aim to reduce ICP, alleviate cerebral edema, ensure patient comfort, and control agitation. The use of hypothermia, barbiturates, and corticosteroids in TBI has been explored, but their efficacy remains inconclusive, prompting a reconsideration of their roles. Lastly, the text touches upon the prophylactic use of phenytoin within the first 7 days following TBI to prevent early post- traumatic seizures, highlighting the limited benefits observed in clinical trials and the current consensus against routine administration in the absence of specific indications. CONCLUSION: In summary, the text delivers a comprehensive overview of TBI management, centering on the pivotal role of ICP in influencing cerebral perfusion. It covers the calculation and alterations of ICP during traumatic brain injuries, emphasizing recommended interventions to maintain optimal ICP levels. The significance of preserving physiological parameters, such as oxygen saturation, blood pressure, and normocapnia, is underscored for optimizing cerebral hemodynamics and minimizing secondary injuries in TBI patients. The text explores a multifaceted approach to TBI management, delving into therapeutic interventions like hypertonic saline, mannitol, sedation, and neuromuscular blockade. It critically evaluates the efficacy of hypothermia, barbiturates, corticosteroids, and prophylactic phenytoin, highlighting the complexities and limitations associated with their use. Overall, the information provided serves as a valuable resource for clinicians and researchers, offering insights into current practices, challenges, and potential avenues for further investigation in the field of TBI management.