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Severe traumatic brain injury (TBI) includes a heterogenous set of injury patterns and affects a wide range of population groups including children, young adults and the elderly. It can cause death or disabling morbidity and is associated with significant socioeconomic burden.

Following the primary injury, a series of metabolic, inflammatory and vascular processes occur which may lead to secondary tissue damage. Additionally, patients with severe TBI are also at increased risk of systemic complications.

The initial resuscitation and subsequent critical care management of patients with TBI focuses on limiting secondary brain injury. This requires a systematic approach to avoid physiological disturbances which may worsen cerebral oxygen delivery and energy substrate metabolism. Factors such as hypotension, hypoxaemia, hypo- and hyperglycaemia and hyperthermia can directly exacerbate the secondary injury and lead to worse outcomes. The maintenance of cerebral perfusion with adequate cerebral oxygenation and energy substrate delivery is critical but may be challenging to achieve.

Management protocols have evolved with international consensus, providing guidelines that can assist clinicians in delivering optimal care.