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Traumatic brain injury (TBI) management focuses on preventing secondary brain injury through aggressive control of intracranial pressure (ICP), which normally remains below 20 mmHg. Elevated ICP can lead to decreased cerebral perfusion pressure, brain herniation, and irreversible neurological damage or death.
Primary brain injury occurs at the moment of trauma, while secondary injury develops from cascading processes including cerebral edema, hemorrhage, and ischemia that increase ICP. The rigid skull creates a fixed compartment where any increase in brain tissue, blood, or CSF volume must be compensated by reduction in other components, following the Monro-Kellie doctrine.
ICP monitoring guides therapeutic interventions including head elevation, sedation, osmotic diuretics like mannitol, and hyperventilation to maintain cerebral perfusion pressure above 60-70 mmHg. Surgical interventions such as decompressive craniectomy may be necessary when medical management fails to control refractory intracranial hypertension.