Traumatic brain injury: pathophysiology, monitoring, and mechanism-based care.

Traumatic brain injury, which may be blunt or penetrating, begins altering intracranial physiology at the moment of impact as primary brain trauma. This article differentiates blunt versus penetrating brain trauma, primary versus secondary brain injury, and subsequent intracranial pathophysiology. Discussion and case study correlate intracranial pathophysiology and multisystem influences on evolving brain injury with mechanism-based interventions to modulate brain components (brain, blood, and cerebrospinal fluid volumes). The discussion also explores the effects of controlled ventilation, cardiopulmonary physiology, and global physiologic state on secondary injury, control of intracranial pressure, and recovery.