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Fig. 1 | World Journal of Emergency Surgery

Fig. 1

From: WSES consensus conference guidelines: monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours

Fig. 1

Consensus algorithm. (1) Lower values could be tolerated, for the shortest possible time, in case of difficult intraoperative bleeding control. (2) Higher threshold could be used in patients “at risk” (i.e., elderly and/or with limited cardiovascular reserve because of pre-existing heart disease). (3) Lower values, temporarily, only in case of impending cerebral herniation. (4) Afterwards, this ratio can be modified according to laboratory values. (5) Not only in case of impending cerebral herniation but also for cerebral edema control. (6) This value should be adjusted (individualized) considering neuromonitoring data and cerebral autoregulation status. (7) This approach is recommended in the absence of possibilities to target the underlying pathophysiologic mechanism of IH. Abbreviations: SMS = systemic multisystem surgery (including radiologic interventional procedures), CT = computed tomography, GCS = Glasgow Coma Scale (mot = motor part of GCS), MAP = mean arterial pressure, SBP = systolic blood pressure, Hb = hemoglobin, PaO2 = arterial partial pressure of oxygen, PaCO2 = arterial partial pressure of carbon dioxide, RBC = red blood cell, P = plasma, PLT = platelet, PT = prothrombin time, aPTT = activated partial thromboplastin time, TEG = thromboelastography, ROTEM = rotational thromboelastometry, ICP = intracranial pressure, CPP = cerebral perfusion pressure, IH = intracranial hypertension, EES extracranial emergency surgery

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