Early airway management in patients with severe traumatic brain injury

Airway management in traumatic brain injury

Abstract

Background and purpose: Traumatic brain injury (TBI) is the main cause of death and disability in injured patients. Airway management in these patients is challenging because unsuccessful endotracheal intubation (ETI) can lead to hypoxemia, hypercapnia, and consecutive secondary brain damage. The aim of this review is to answer the questions about appropriate airway management in patients with severe TBI.

Materials and methods: We searched the PubMed database using keywords of our paper: „airway management“, „traumatic brain injury“ and „intubation”. During the period from January 2010 to January 2025, 213 articles were published, relevant for this review.

Discussion: The difficulty of obtaining an airway in patients with TBI is a consequence of presence of airway reflexes and muscular tone, the necessity to maintain cervical spine stabilization, and presence of blood and secretions in the upper airway. Influence of ETI on intracranial pressure and cerebral blood flow can also determine outcome. An alternative way for airway management is the use of supraglottic airway devices. Rapid sequence intubation (RSI) as a form of ETI for patients with severe TBI is an appropriate choice with the use of sedatives, hypnotics, opioid analgesics, and muscle relaxants to prevent an increase in intracranial pressure. ETI in patients with cervical spine injury should be done using manual in-line stabilization and video laryngoscope.

Conclusions: Airway management in patients with severe TBI is essential because it can influence mortality. TBI patients with airway compromise must be identified, and airway must be secured early to ensure ventilation and oxygenation.