Traumatic brain injury in infants and children - Mechanisms of secondary damage and treatment in the intensive care unit

After traumatic brain injury (TBI), irreparable brain damage, termed primary injury, results from direct disruption of brain parenchyma. Potentially reversible secondary injury, caused by altered hemodynamic and respiratory functions and cellular derangement, also takes place. Traumatic brain injury triggers a common pathway of neuronal death involving posttraumatic ischemia, energy failure, excitotoxicity, mitochondrial failure, oxidative stress, and secondary cerebral swelling. In this article, the experimental and clinical data on secondary mechanisms of TBI pathophysiology and current therapeutic strategies are discussed.