The latest French Guidelines for the management in the first 24hours of patients with
severe traumatic brain injury (TBI) were published in 1998. Due to recent changes
(intracerebral monitoring, cerebral perfusion pressure management, treatment of raised
intracranial pressure), an update was required. Our objective has been to specify
the significant developments since 1998. These guidelines were conducted by a group
of experts for the French Society of Anesthesia and Intensive Care Medicine (Société
francaise d'anesthésie et de réanimation [SFAR]) in partnership with the Association
de neuro-anesthésie-réanimation de langue française (ANARLF), The French Society of
Emergency Medicine (Société française de médecine d'urgence (SFMU), the Société française
de neurochirurgie (SFN), the Groupe francophone de réanimation et d'urgences pédiatriques
(GFRUP) and the Association des anesthésistes-réanimateurs pédiatriques d'expression
française (ADARPEF). The method used to elaborate these guidelines was the Grade®
method. After two Delphi rounds, 32 recommendations were formally developed by the
experts focusing on the evaluation the initial severity of traumatic brain injury,
the modalities of prehospital management, imaging strategies, indications for neurosurgical
interventions, sedation and analgesia, indications and modalities of cerebral monitoring,
medical management of raised intracranial pressure, management of multiple trauma
with severe traumatic brain injury, detection and prevention of post-traumatic epilepsia,
biological homeostasis (osmolarity, glycaemia, adrenal axis) and paediatric specificities.