Trauma is the 5th leading cause of death in Singapore and remains the leading cause of death in young adults. Traumatic brain injury (TBI) accounts for up to 75% of trauma-related deaths. The National Neuroscience Institute provides highly specialised care for acutely brain injured patients. Clinical services for brain injured patients include emergency resuscitative care, timely surgical treatment and neuro-intensive care management, facilitated by a dedicated team in our neurointensive care unit.
Neurointensive care is a subspeciality discipline that deals with application of critical care principles to patients with critical neurologic illness. Patients with severe head injury are often managed in specialised modern neurointensive care units run by both neurosurgeons and neurointensivists (an anaesthetist specialised in neurosurgical intensive care). Protocol driven strategies are employed, and these have been shown to improve patient outcomes.
The aims of management are to prevent further brain damage (secondary damage), protect vulnerable areas (ischaemic areas) in the brain, allow the brain to autoregulate (regulate its own blood flow) and to detect any adverse effects (e.g, expanding mass lesion). Multimodality monitoring is common place in many neurointensive care units. This includes the monitoring of intracranial pressure (ICP), cerebral perfusion pressure (CPP), tissue oxygenation (PtiO2), brain temperature, pressure reactivity (PRx), cerebral blood flow (CBF) and jugular venous saturation (SjvO2). Not only does it allow the timely detection of adverse events, it allows us to optimize treatment. Surgery in itself, forms only part of the intensive care unit.
For patients with post-traumatic cognitive and behavioural deficits, long-term care is coordinated with the traumatic brain injury rehabilitation services.
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