High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury.
In a five-center study, 73 patients with severe head injury and elevated intracranial pressure (ICP) were randomly assigned to receive either a regimen that included high-dose pentobarbital or one that was otherwise similar but did not include pentobarbital. The results indicated a 2:1 benefit for those treated with the drug with regard to ICP control. When patients were stratified by prerandomization cardiac complications, the advantage increased to 4:1. A multiple logistic model considering treatment and selected baseline variables indicated a significant positive treatment effect of barbiturates, a significant effect of time from injury to randomization, and an interaction of treatment with cardiovascular complications. However, of 925 patients potentially eligible for randomization, only 12% met ICP randomization criteria. The results support the hypothesis that high-dose pentobarbital is an effective adjunctive therapy, but that it is indicated in only a small subset of patients with severe head injury.
Eisenberg
H M
HM
Division of Neurosurgery, University of Texas Medical Branch, Galveston.
Frankowski
R F
RF
Contant
C F
CF
Marshall
L F
LF
Walker
M D
MD
D000293:Adolescent; D000328:Adult; D002986:Clinical Trials as Topic; D003128:Coma / Q000503:physiopathology; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects*; D008875:Middle Aged; D008962:Models, Theoretical; D010424:Pentobarbital / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D011379:Prognosis; D011897:Random Allocation; D012720:Severity of Illness Index
D010424:Pentobarbital