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Management of traumatic brain injury requires careful and targeted management of the physiological consequences which extend beyond the scope of the primary impact to the cranium. Here, we present a review of the principles of its acute management in adults. We outline the procedure which patients are assessed and the critical physiological variables which must be monitored to prevent further neurological damage. We describe current interventional strategies from the context of the underlying physiological mechanisms and recent clinical data and identify persisting challenges in traumatic brain injury management and potential avenues of future progress.<\/jats:p>","DOI":"10.1177\/17504589231187798","type":"journal-article","created":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T07:33:57Z","timestamp":1693467237000},"page":"122-128","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Perioperative management of adults with traumatic brain injury"],"prefix":"10.1177","volume":"34","author":[{"given":"Chinazo","family":"Okeke","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0853-9978","authenticated-orcid":false,"given":"Jenny","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Bashford","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5850-125X","authenticated-orcid":false,"given":"Matthew","family":"Seah","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,8,31]]},"reference":[{"key":"bibr1-17504589231187798","unstructured":"Alvis-Miranda HR, Castellar-Leones SM, Moscote-Salazar LR 2014 Intravenous fluid therapy in traumatic brain injury and decompressive craniectomy Bulletin of Emergency and Trauma 2 (1) 3\u201314 Available at https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4771253\/"},{"key":"bibr2-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00337-4"},{"key":"bibr3-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181d8cf2b"},{"key":"bibr4-17504589231187798","doi-asserted-by":"publisher","DOI":"10.4097\/kjae.2018.71.1.12"},{"key":"bibr5-17504589231187798","doi-asserted-by":"publisher","DOI":"10.4103\/2045-9912.285561"},{"key":"bibr6-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1093\/bjaceaccp\/mkt010"},{"key":"bibr7-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2013.06.002"},{"key":"bibr8-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-021-01296-z"},{"key":"bibr9-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30499-X"},{"key":"bibr10-17504589231187798","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1992.76.2.0207"},{"key":"bibr11-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1177\/0885066610366919"},{"key":"bibr12-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1007\/s11940-018-0518-1"},{"key":"bibr13-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1017\/S1481803500012471"},{"key":"bibr14-17504589231187798","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2017.00250"},{"key":"bibr15-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.5.5.630"},{"key":"bibr16-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-018-0991-8"},{"key":"bibr17-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1080\/02699052.2018.1469045"},{"key":"bibr18-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30415-0"},{"key":"bibr19-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000135158.42242.B1"},{"key":"bibr20-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003761"},{"key":"bibr21-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2020.07.054"},{"key":"bibr22-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00309-X"},{"key":"bibr23-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-014-2021-0"},{"key":"bibr24-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.56.12.1746"},{"key":"bibr25-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aem128"},{"key":"bibr26-17504589231187798","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2000.92.4.0606"},{"key":"bibr27-17504589231187798","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2018.07.001"},{"key":"bibr28-17504589231187798","unstructured":"NICE 2014 Introduction. 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