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Critical Care Issues in Mechanical Ventilation 507

TABLE 15-8 Assessment of Impairment Due to Traumatic Brain Injury

Term Finding
Cloudy A mild deficit in processing information by the brain
consciousness Short-term memory is diminished but long-term memory remains intact

Lethargy Decrease in alertness, rouse briefly in response to stimuli, impaired ability
to perform task, aware of surrounding, return to inactivity when left alone

Obtundation Decrease in awareness and alertness, rouse briefly in response to stimuli,
unable to perform task, unaware of surrounding, return to inactivity
when left alone

Stupor Cannot communicate clearly but can be aroused by painful stimulation
Coma Does not respond to vigorous stimulations

Brain death Irreversible cessation of whole brain function as documented by EEG
(Crippen, 2011.)
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management Strategies

In mild TBI, rest and pain relievers are usually sufficient to treat a headache. The
patient is typically monitored closely at home and scheduled with a follow-up medi-
cal appointment for any persistent or worsening symptoms. In moderate to severe
TBI, oxygenation and circulatory supports are essential. Diuretics, antiseizure
drugs, and coma-inducing drugs may be used as indicated to reduce intracranial
pressure and preserve brain function (mayoclinic.com, 2012).
The primary goal in the management of severe TBI is to prevent secondary neuro-
nal injury and to avoid further loss of neurons. This condition should be managed
by the following procedures (trauma.org , 2011):
1
1. Protect airway
2. Provide eucapnic ventilation and adequate oxygenation to correct cerebral
hypoxia
3. Correct hypovolemia and hypotension to provide adequate systolic and mean
arterial pressures
4. CT scan as needed to evaluate severity and response to treatments
5. Neurosurgery as indicated to treat swelling and edema, and to reduce elevated
ICP
6. Intensive care monitoring and management

Systolic pressure should be kept above 90 mm Hg (Brain Trauma Foundation,
2011). Hypovolemia and hypotension may be managed by control of hemorrhage
and fluid administration. A CT scan of the head can be helpful to determine the
presence of epidural or subdural hematoma. A surgical decision can be made based
on the size of intracranial lesion.

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