Paradigm Shifts in Critical Care Neurology: Evidence-Based Approaches to Severe Acute Encephalopathy Management

Export Severe acute encephalopathy represents a significant challenge in critical care medicine, characterized by altered consciousness, cognitive dysfunction, and potential neurological sequelae. This review critically examines the current evidence base for management strategies in the intensive care unit, with particular focus on advances made through mid-2024. By synthesizing findings from recent randomized controlled trials and systematic reviews, we evaluate the efficacy of targeted temperature management, intracranial pressure monitoring, and individualized hemodynamic approaches. Recent evidence from major trials, including the Targeted Temperature Management 2 (TTM-2) trial, the Prophylactic Hypothermia Trial to Lessen Traumatic Brain Injury (POLAR), the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure (BEST-TRIP), the Blood Pressure and Oxygenation Targets in Post-Resuscitation Care (BOX) trial, and the Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intracranial Pressure (RESCUEicp) trial, has challenged traditional paradigms and supports more individualized management protocols. This review concludes that management of severe acute encephalopathy requires a multidisciplinary approach with treatment tailored to specific pathophysiological mechanisms, while emphasizing the need for continued research to address ongoing controversies.