Catastrophic Brain Injury Guidelines
These guidelines are to preserve organ function in the neurologically-devastated patient.
Organ donation should not be mentioned to the patient’s family. LifeNet Health will consult with the healthcare team before discussing donation options with the family.
Maintain SBP>100 (MAP>60)
- Consider invasive hemodynamic monitoring (arterial monitoring and central venous access)
- Adequate hydration: adequate volume resuscitation to maintain euvolemia
- Vasopressor support: If hypotensive post adequate rehydration, use Neosynephrine as the first pressor of choice up to 2mcg/kg/min, followed by Dopamine
Maintain Urine Output >0.5ml/kg/hr<400ml/hr(consider DI if >400ml/hr x 2 hrs)
- Treat DI with Vasopressin drip 1-2.5 units/hr, if UO still >400ml/hr
- If UO falls below 0.5ml/kg/hr, assess fluid status—may need rehydration or BP support
Maintain PO2> 100 and pH 7.35-7.45
Adequate ventilation maintained by:
- Peep 5.0-8.0
- Aggressive pulmonary hygiene if not contraindicated by patient’s condition (suction and turn every 2 hrs)
- Respiratory treatments to prevent bronchospasm
Hypothermia
Maintain core body temperature between 36°C and 37.5°C
Labs
- Basic metabolic panel, magnesium, phosphate, heme8, ABG’s, liver panel, initially and as needed
- Maintain Hgb>8g/dL and Hct >30%
- If PT>18, give 2 units FFP
- Monitor and treat electrolytes as needed
- Monitor glucose and treat with insulin drip if needed (keep 80-200)
- Maintain Na < 155 mmol/L
- Blood bank sample for ABO typing