Anesthesiological approach to traumatic brain injury

Traumatska ozljeda mozga predstavlja izazovan problem za zdravstvo. Sama bolest je još nedovoljno istražena, što otežava zbrinjavanje. Uz to, posljedice bolesti pokazuju značajnu varijabilnost, od potpunog oporavka, preko dugotrajnih posljedica, pa sve do smrtnog ishoda. Ukoliko dođe do kroničnih posljedica, sam zdravstveni sustav se dodatno opterećuje troškovima dugotrajnog praćenja i zbrinjavanja. Zbog toga je bitno da algoritmi zbrinjavanja budu što kvalitetniji, kako bi ishodi liječenja traumatske ozljede mozga bili što je moguće bolji. Neki iskoraci su već postignuti pomoću regulacije intrakranijalnog tlaka (ICP), što posljedično povoljno utječe na cerebralni protok krvi (CBF) koji ima djelovanje na cerebralni perfuzijski tlak (CPP) i u krajnjoj liniji na homeostazu mozga. Regulacije intrakranijalnog tlaka se ostvaruje kroz više terapijskih postupaka koji se mogu podijeliti na farmakološke, nefarmakološke, i kirurške. Farmakološki postupci se sastoje od hiperosmolarne terapije, uporabe anestetika, analgetika i sedativa, te profilakse infekcija, duboke venske tromboze i epileptičkih napadaja. Nefarmakološke metode uključuju profilaktičku hipotermiju, drenažu cerebrospinalne tekućine, ventilacijsku terapiju, te adekvatnu nutritivnu podršku. Kirurška terapija se trenutno bazira na dekompresivnoj kraniektomiji. Sva ova područja su još uvijek predmet rasprave i aktivnog istraživanja što daje nadu da će doći do novih otkrića i poboljšanja terapije za pacijente.Traumatic brain injury presents a challenging problem for healthcare. The disease itself is still insufficiently researched, which makes treatment difficult. In addition, the consequences of the disease show significant variability, from complete recovery, through long-term consequences, and even death. If there are chronic consequences, the healthcare system itself is additionally burdened with the costs of long-term monitoring and treatment. For this reason, it is important that the care algorithms are of the highest quality, so that the outcomes of the treatment of traumatic brain injury are as good as possible. Some progress has already been achieved by regulating intracranial pressure (ICP), which consequently favourably affects cerebral blood flow (CBF) which has an effect on cerebral perfusion pressure (CPP) and ultimately brain homeostasis. Regulation of intracranial pressure is achieved through several therapeutic procedures that can be divided into pharmacological, non-pharmacological and surgical. Pharmacological procedures consist of hyperosmolar therapy, the use of anaesthetics, analgesics and sedatives, as well as prophylaxis of infections, deep vein thrombosis and epileptic seizures. Non-pharmacological methods include prophylactic hypothermia, cerebrospinal fluid drainage, ventilation therapy, and adequate nutritional support. Surgical therapy is currently based on decompressive craniectomy. All these areas are still the subject of debate and active research, which gives hope for new discoveries and improvements in therapy for patients