**1. Introduction**

The major focus on traumatic brain injury (TBI) management is to avoid and restrain ongoing brain damage and to increase brain recovery chances by reducing brain edema and intracranial pressure (ICP). Optimizing oxygenation, perfusion, nutrition, glycaemia and temperature homeostasis are paramount [1]. In this chapter, we will discuss the role of oxygenation in TBI management with a special focus on early indication of tracheostomy (TQT) as a support to oxygen therapy.

### **2. Incidence and prevalence of TBI**

TBI is a critical public health concern with large socioeconomic repercussions. The main causes of TBI include violence, falls and road traffic accidents [2]. In 2010, the global burden of disease (GBD) reported 89% of trauma-related deaths occurring in low- and middle-income countries (LMICs) [3]. In 2030, the worldwide estimated incidence of TBI places this type of trauma as a 4th leading cause of lost disability adjusted life years (DAYLS) and 7th cause of death [4].

The Centers for Disease Control and Prevention (CDC) estimated 2.53 million emergency department (ED) visits, 288.000 hospitalizations and 56.800 deaths related to TBI, in 2014 [5]. The TBI's lifetime economic costs (direct and indirect medical costs) was estimated at \$76.5 billion (2010) and fatal TBIs can account for up to 90% of total medical costs. Since TBI is a growing health burden, it is an utmost importance the optimization of hospital resources and staff [2, 6].

TBI can be classified following its severity: Mild, Moderate and Severe [7]. This classification is based on the Glasgow Coma Scale (GCS), with Mild - GCS Score 13–15; Moderate - GCS Score 9–12; and Severe - GCS Score 8–3. Subsequent TBI management will rely on the first evaluation and the prevention of secondary injuries.
