Traumatic Brain Injury (TBI) Clinical Pathway — Emergency Department and ICU
Traumatic Brain Injury (TBI) Clinical Pathway — Emergency Department and ICU
Decompressive Craniectomy Criteria
Criteria
Notify PICU and Neurosurgery Attendings, and Trauma fellow discussion of indication for decompressive craniectomy:
- Persistent ICP > 20 with/without PbtO2 < 15 / CPP < 40 that fails to respond to escalation of therapies, including:
- Adjusting HOB
- Loosening collar
- Increased sedation & analgesia
- Failure to control seizures
- 3% hypertonic saline bolus + infusion
- Neuromuscular blockade bolus + infusion
- Hyperventilation
- Pentobarbital bolus + infusion