Intracranial hypertension in head injury: management and results.

Abstract:

OBJECTIVE:(1) To describe the pattern of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in a group of severe head-injured patients, (2) to quantify complications of ICP monitoring, and (3) to describe a management protocol and its results. DESIGN:Prospective observational study. SETTING:General intensive care unit in a teaching hospital. PATIENTS:138 comatose patients, selected according to the following criteria: age > 16 years, coma [Glasgow Coma Scale (GCS) < or = 8] with at least one pupil reactive after resuscitation, digital recording of intracranial and arterial pressure, and jugular saturation measurements. MEASUREMENTS AND RESULTS:Median GCS was 5, and 62 patients had significant extracranial injuries; 71 had intracranial hematomas, which were urgently evacuated. Mean ICP was 20.5 mmHg (SD 8.34), mean CPP was 71.86 mmHg (SD 11.22); cerebral extraction of oxygen averaged 29 %. Medical therapy was used to control ICP in 130 cases; 93 patients required hyperventilation. Vasopressors were infused in 16 cases; in 14 cases a barbiturate infusion was started. In 6 patients all pharmacological treatments failed and surgical decompression was done. The only complication of ICP monitoring was meningitis in 3 patients. Outcome at 6 months was a good recovery and moderate disability for 82 patients (59.4%), severe disability and vegetative status for 37 (26.8%), and 19 patients died (13.7%). The severity of intracranial hypertension was related to poorer results at 6 months. CONCLUSIONS:Intracranial hypertension is very frequent in severe head injury but can be reasonably well controlled by combined surgical and medical therapy.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Stocchetti N,Rossi S,Buzzi F,Mattioli C,Paparella A,Colombo A

doi

10.1007/s001340050860

keywords:

subject

Has Abstract

pub_date

1999-04-01 00:00:00

pages

371-6

issue

4

eissn

0342-4642

issn

1432-1238

journal_volume

25

pub_type

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