Key messages

• The fundamental aim of postneurosurgical intensive care is to protect the brain from ischemic damage.

• Protection of the brain is achieved by balancing cerebral substrate supply and demand.

• Barbiturates and other anesthetic agents which decrease cerebral metabolic demand have been used for protection of the brain, but there is limited evidence for their efficacy.

• Fluid restriction after brain injury is contraindicated and does not reduce brain swelling.

• Plasma glucose levels should be maintained within normal limits as hyperglycemia is associated with poor outcome after brain injury.

• Moderate hypothermia protects the brain by mechanisms other than a simple reduction in cerebral metabolic rate.

• Specific therapies for protection against mediators of cerebral injury are being investigated.

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