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Head injury transfer physiological targets — DIPIMC MCQ

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HardRetrieval and TransportHead injury transfer physiological targetsDIPIMCDipIMC

An intubated patient with a severe traumatic brain injury is being transferred to a neurosurgical unit, and during the journey you aim to minimise secondary brain injury. Which set of physiological targets is most appropriate?

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Correct answer: B — Saturations 94-98%, normocapnia and systolic above 110 mmHg

Secondary brain injury is driven by hypoxia, hypotension and abnormal carbon dioxide, so transfer targets are oxygen saturations of 94 to 98%, normocapnia (end-tidal CO2 around 4.5 to 5.0 kPa), and a systolic above 110 mmHg or a mean arterial pressure sufficient for cerebral perfusion. Routine hyperventilation causes cerebral vasoconstriction and ischaemia and is reserved as a brief temporising measure for signs of imminent herniation. Permissive hypotension suits uncontrolled truncal haemorrhage but is harmful in isolated brain injury, where cerebral perfusion pressure must be maintained. Pearl: even a single episode of hypotension or hypoxia measurably worsens outcome after traumatic brain injury.

Reference: NICE NG232 (Head injury); ATACC