TBI

Question 1

Decompressive Craniectomy

Answer 1

• DECRA Trial (2011): Early decompressive craniectomy in patients with severe TBI and refractory intracranial hypertension resulted in less time in ICU but worse functional outcomes at 6 months compared to standard care.
• RESCUEicp Trial (2016): Decompressive craniectomy resulted in lower mortality but higher rates of vegetative state, lower severe disability, and upper severe disability compared to medical management in TBI patients with refractory raised intracranial pressure (ICP).

Question 2

Hypothermia in TBI

Answer 2

• Eurotherm3235 Trial (2015): In patients with TBI, hypothermia plus standard care to reduce ICP led to worse outcomes at 6 months than standard care alone.
• POLAR Trial (2018): Early prophylactic hypothermia did not improve neurologic outcomes at 6 months in patients with severe TBI.

Question 3

Hypertonic Saline vs. Mannitol

Answer 3

• SAFE-TBI (2007): The use of albumin for fluid resuscitation in TBI patients led to worse outcomes compared to saline.

Question 4

ICP Monitoring in TBI

Answer 4

• BEST TRIP (2012): In severe TBI, care focused on maintaining monitored ICP at 20 mm Hg or less was not shown to be superior to care based on imaging and clinical examination.