Management of comatose head-injured patients: are we getting any better?
This re-survey of neurosurgical centres was conducted to determine whether the publication of management guidelines has resulted in changes in the intensive care management of severely head-injured patients (defined as Glasgow Coma Score < 9) in the UK and Ireland. Results were compared with data collected from a similar survey conducted 2 years earlier. Almost 75% of centres monitor intracranial pressure in the majority of patients and 80% now set a target cerebral perfusion pressure of > 70 mmHg. The use of prolonged hyperventilation (> 12 h) is declining and the target PaCO2 is now most commonly > 4 kPa. More centres maintain core temperature < 36.5 degrees C. Although wide variations in the management of severely head-injured patients still exist, we found evidence of practice changing to comply with published guidelines.
Wilkins
I A
IA
Department of Anaesthesia and Neurosciences Critical Care Unit, Box 93, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.
Menon
D K
DK
Matta
B F
BF
D003128:Coma / Q000628:therapy*; D006259:Craniocerebral Trauma / Q000628:therapy*; D003422:Critical Care / Q000379:methods / Q000592:standards*; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D019586:Intracranial Hypertension / Q000628:therapy; D007494:Ireland; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D006113:United Kingdom