Traumatic brain injury occurs in 500000 persons each year in the United States; approximately 50000 of these die before they reach a hospital. Of those who do reach a hospital, approximately 80% have mild traumatic injuries (Glasgow Coma Scale [GCS] score 14–15) and require little, if any, care in an intensive care unit (ICU). About 10% have moderate traumatic brain injuries (GCS score 9–13) and may be admitted to an ICU simply for observation. For the remaining 10% (approximately 45000 patients), who have severe traumatic brain injury (GCS score 3–8), rapid intervention and stabilization in an ICU can improve morbidity and mortality.1 

Initially, patients with severe traumatic brain injury are in an extremely unstable condition and may require surgery for removal of epidural and/or subdural hematomas and repeated computed tomography scans. They may need intracranial pressure monitoring, hyperosmolar...

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