Management of severe traumatic brain injury (first 24 hours)

The latest French Guidelines for the management in the first 24 hours of patients with severe traumatic brain injury (TBI) were published in 1998. Due to recent changes (intracerebral monitoring, cerebral perfusion pressure management, treatment of raised intracranial pressure), an update was required. Our objective has been to specify the significant developments since 1998. These guidelines were conducted by a group of experts for the French Society of Anesthesia and Intensive Care Medicine (Societe francaise d'anesthesie et de reanimation [SFAR]) in partnership with the Association de neuro-anesthesie-reanimation de langue francaise (ANARLF), The French Society of Emergency Medicine (Societe francaise de medecine d'urgence (SFMU), the Societe francaise de neurochirurgie (SFN), the Groupe francophone de reanimation et d'urgences pediatriques (GFRUP) and the Association des anesthesistes-reanimateurs pediatriques d'expression francaise (ADARPEF). The method used to elaborate these guidelines was the Grade (R) method. After two Delphi rounds, 32 recommendations were formally developed by the experts focusing on the evaluation the initial severity of traumatic brain injury, the modalities of prehospital management, imaging strategies, indications for neurosurgical interventions, sedation and analgesia, indications and modalities of cerebral monitoring, medical management of raised intracranial pressure, management of multiple trauma with severe traumatic brain injury, detection and prevention of post-traumatic epilepsia, biological homeostasis (osmolarity, glycaemia, adrenal axis) and paediatric specificities. (C) 2017 The Authors. Published by Elsevier Masson SAS on behalf of Societe francaise d'anesthesie et de reanimation (Sfar).