Intracranial hypertension in head injury: management and results.
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.


METHODS
Prospective observational study.


METHODS
General intensive care unit in a teaching hospital.


METHODS
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.


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.
Stocchetti
N
N
Department of Anesthesia and Intensive Care, Ospedale Maggiore, Policlinico IRCCS, Milano, Italy. stocchet@polic.cilea.it
Rossi
S
S
Buzzi
F
F
Mattioli
C
C
Paparella
A
A
Colombo
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D006259:Craniocerebral Trauma / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging / Q000628:therapy*; D007427:Intracranial Pressure; D007558:Italy; D007773:Lactates / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D007773:Lactates; D010100:Oxygen