A standardized neurosurgical neurointensive therapy directed toward vasogenic edema after severe traumatic brain injury: clinical results.
OBJECTIVE
Analysis of a standardized therapy focusing on prevention and treatment of vasogenic edema in patients suffering severe traumatic brain injury (TBI).


METHODS
A retrospective analysis.


METHODS
Neurointensive care unit at Sahlgrenska University Hospital, Göteborg, Sweden.


METHODS
38 patients with severe TBI were included. The median Glasgow Coma Score was 5 (range 3-8) and median age 27 years (range 5-70 years).


METHODS
Measurement of intracranial pressure (ICP). Surgical evacuation of hematomas and contusions. Volume expansion aiming at normovolemia. Sedation with continuous intravenous infusion of low-dose thiopentone and reduction of stress response by clonidine. Normalization of capillary hydrostatic pressure by metoprolol and clonidine. If ICP and cerebral perfusion pressure (CPP) were not stabilized (ICP < 20 mmHg and CPP > 60 mm Hg), a continuous infusion of dihydroergotamine was added. In 4 patients a craniectomy was performed.


RESULTS
Of the 38 patients, 27 (71%) survived with good recovery or moderate disability, 5 (13%) survived with severe disability, 1 (3%) remained in a vegetative state, and 5 (13%) died. The mortality due to intracranial hypertension was 11% (4 patients).


CONCLUSIONS
A therapy focusing on treatment of the assumed vasogenic edema in combination with aggressive neurosurgery resulted in an outcome as good as the best previously reported.
Naredi
S
S
Department of Anesthesiology and Intensive Care, Institute of Surgical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden. Peter.Naredi@surgery.umu.se
Edén
E
E
Zäll
S
S
Stephensen
H
H
Rydenhag
B
B
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D001930:Brain Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003422:Critical Care / Q000592:standards*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000592:standards*; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000628:therapy*