Citation

Blissitt PA. AACN Adv. Crit. Care 2012; 23(2): 188-203.

Affiliation

Patricia A. Blissitt is Neuroscience Clinical Nurse Specialist, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104, and, Assistant Professor, Clinical Faculty, University of Washington School of Nursing, Seattle, WA 98195 (pbliss@u.washington.edu).

Copyright

(Copyright © 2012, Lippincott Williams and Wilkins)

DOI

10.1097/NCI.0b013e31824db4f3

PMID

22543492

Abstract

Despite progress in the management of adults with severe traumatic brain injury, several controversies persist. Among the unresolved issues of greatest concern to neurocritical care clinicians and scientists are the following: (1) the best use of technological advances and the data obtained from multimodality monitoring; (2) the use of mannitol and hypertonic saline in the management of increased intracranial pressure; (3) the use of decompressive craniectomy and barbiturate coma in refractory increased intracranial pressure; (4) therapeutic hypothermia as a neuroprotectant; (5) anemia and the role of blood transfusion; and (6) venous thromboembolism prophylaxis in severe traumatic brain injury. Each of these strategies for managing severe traumatic brain injury, including the postulated mechanism(s) of action and beneficial effects of each intervention, adverse effects, the state of the science, and critical care nursing implications, is discussed.

Language: en