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Abstract: A significant improvement in patient outcomes can be achieved by in-hos
pital interventions aimed at the prevention of secondary brain injury. The Guidelines for the Management of Severe Head Injury is a scientific, evidence-based document that evaluates the current evidence for practice and interventions to reduce secondary brain injury and improve outcome for traumatic brain injury (TBI) patients. The Guidelines covers a wide range of topics including trauma systems, oxygenation and blood pressure resuscitation, intracranial pressure monitoring, intracranial hypertension, nutrition, and pharmacological interventions for the severe TBI patient in the intensive care environment. Head injury care requires an interdisciplinary approach involving emergency room personnel, trauma nurses, and critical care nurses. Critical care nurses will find this document especially applicable because secondary brain injuries are often the result of events that occur in the ICU setting: hypoxemia, hypotension, and intracranial hypertension.
Introduction
Critical care neuroscience nurses are confronted every day with making treatment choices for patients with severe traumatic brain injury (TBI). Treatment often varies depending on the region of the country, hospital facilities, and physician and nurse experience. These variations in treatment were documented in a survey published in 1995 by Ghajar et al.10 Level I, II, and III trauma centers were questioned about their treatment protocols for managing patients with TBI. Of all trauma centers surveyed, only 28% routinely performed intracranial pressure (ICP) monitoring. Corticosteroids were administered more than half of the time in 64% of the centers, and one-third of the centers reported utilizing hyperventilation with a goal of maintaining the partial pressure of arterial carbon dioxide [PaCO^sub 2^] less than 25 mm Hg. This report sparked the neurosurgical community to re-examine its role in providing quality care to neurotrauma patients.
The Brain Trauma Foundation, in a joint initiative with the American Association of Neurological Surgeons (AANS) and the Joint Section on Neurotrauma and Critical Care, developed a task force that researched the scientific basis for past and present treatments for TBI patients. The end result was the Guidelines for the Management of Severe Head Injury.ll The Guidelines, endorsed by the AANS and the World Health Organization's Neurotrauma Committee, is the first scientific evidence-based document that evaluates the current evidence for practice and intervention: to reduce secondary brain injury...