Brain tissue oxygen monitoring in severe brain injury, II. Implications for critical care teams and case study.

To purchase reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 8092273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, [email protected]. that includes a discussion of appropriate management of intracranial pressure (ICP) and cerebral perfusion pressure (CPP). An algorithm outlines a tiered approach to avoid secondary injury. The literature review in the guidelines and a review of the Traumatic Coma Data Bank clearly indicate that the avoidance of early hypoxia and hypotension and a rapid resuscitation and evacuation of intracranial hematomas are necessary and could improve the chances for a good outcome. Mary Kay Bader, RN, MSN, CCRN, CNRN Linda R. Littlejohns, RN, MSN, CCRN, CNRN Karen March, RN, MN, CCRN, CNRN Research related to the effects of certain interventions on brain tissue oxygen monitoring was presented in part I: “Research and Usefulness in Critical Care.” In this article, we continue the discussion of brain tissue oxygen monitoring and its effects on patients with severe traumatic brain injury. First, we describe how the interventions of critical care teams are integrated to maintain adequate brain oxygenation as patients progress through the critical phases of hospitalization. Second, we define critical-thinking algorithms that allow the team to implement sequenced interventions to maintain patients with traumatic brain injury in the zone of control. Last, we apply that theoretical and practical information to an actual case study, allowing readers to follow a case and analyze the interventions used to optimize a patient’s recovery.