Impact of rapid sequence intubation on intracranial pressure and cerebral perfusion in patients with traumatic brain injury: a scoping review
DOI:
https://doi.org/10.71112/g3wtt473Keywords:
Traumatic brain injury, rapid sequence intubation, intracranial pressure, cerebral perfusion pressure, hemodynamics, airway management, ketamine, dexmedetomidine, neurocritical care, hypoxia, hypotensionAbstract
Traumatic brain injury represents a major cause of morbidity and mortality, in which the prevention of secondary brain injury is critical. Rapid sequence intubation is a commonly performed intervention in the initial management; however, it may induce alterations in intracranial pressure and cerebral perfusion. A scoping review was conducted following PRISMA-ScR methodology to map the available evidence regarding the impact of rapid sequence intubation on intracranial pressure and cerebral perfusion pressure in adult patients with traumatic brain injury.
A total of 20 studies were included after screening 500 initial records, comprising randomized controlled trials, observational studies, and systematic reviews. Findings indicate that the impact of rapid sequence intubation on intracranial dynamics is multifactorial, depending on the phase of the procedure, the choice of pharmacological agents, and hemodynamic and ventilatory control. The evidence suggests that post-intubation hypotension and hypoxemia have a greater negative effect on cerebral perfusion than transient increases in intracranial pressure. Additionally, ketamine is associated with a favorable hemodynamic profile and does not demonstrate a harmful increase in intracranial pressure, whereas dexmedetomidine emerges as a useful adjuvant in selected clinical contexts.
Strategies to mitigate intracranial impact should be approached through a multimodal framework, including optimization of preoxygenation, carbon dioxide control, prevention of hypotension, and techniques that maximize first-pass intubation success. The available evidence presents methodological limitations, with a predominance of observational studies and heterogeneity in measurement methods.
In conclusion, rapid sequence intubation in patients with traumatic brain injury should be considered a neurocritical intervention, in which the preservation of cerebral perfusion and comprehensive physiological control are essential to improve clinical outcomes.
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Copyright (c) 2026 Gabriela Alexandra Segovia Torres, Carlos Augusto Tinitana Soto, Diego Darío Salazar Corrales, Silvia Katherine Machado Barrera, Sandra Del Rocio Morocho Imbacuan (Autor/a)
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