The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Resuscitation of blood pressure and oxygenation.

Abstract

Early postinjury episodes of hypotension or hypoxia greatly increase morbidity and mortality from severe head injury. At present, defining level of hypotension and hypoxia is unclear in these patients. However, ample class II evidence exists regarding hypotension, defined as a single observation of a systolic blood pressure of <90/mm Hg, or hypoxia, defined as apnea/cyanosis in the field or a PaO2 < 60 mm Hg by arterial blood gas analysis, to warrant the formation of guidelines stating that these values must be avoided, if possible, or rapidly corrected in severe head injury patients. A significant proportion of adult and pediatric TBI patients are discovered to be hypoxemic or hypotensive in the prehospital setting. Patients with severe head injury that are intubated in the prehospital setting appear to have better outcomes. Strong class II evidence suggests that raising the blood pressure in hypotensive, severe head injury patients improves outcome in proportion to the efficacy of the resuscitation.