Intensive care management of head-injured patients in Europe: a survey from the European brain injury consortium.
OBJECTIVE
(a) to describe current practice in the monitoring and treatment of moderate and severe head injuries in Europe; (b) to report on intracranial pressure and cerebral perfusion pressure monitoring, occurrence of measured and reported intracranial hypertension, and complications related to this monitoring; (c) to investigate the relationship between the severity of injury, the frequency of monitoring and management, and outcome.


METHODS
A three-page questionnaire comprising 60 items of information has been compiled by 67 centres in 12 European countries. Information was collected prospectively regarding all severe and moderate head injuries in adults (> 16 years) admitted to neurosurgery within 24 h of injury. A total of 1005 adult head injury cases were enrolled in the study from 1 February 1995 to 30 April 1995. The Glasgow Outcome Scale was administered at 6 months.


RESULTS
Early surgery was performed in 346 cases (35%); arterial pressure was monitored invasively in 631 (68%), ICP in 346 (37%), and jugular bulb saturation in 173 (18%). Artificial ventilation was provided to 736 patients (78%). Intracranial hypertension was noted in 55% of patients in whom ICP was recorded, while it was suspected in only 12% of cases without ICP measurement. There were great differences in the use of ventilation and CPP monitoring among the centres. Mortality at 6 months was 31%. There was an association between an increased frequency of monitoring and intervention and an increased severity of injury; correspondingly, patients who more frequently underwent monitoring and ventilation had a less favourable outcome.


CONCLUSIONS
In Europe there are great differences between centres in the frequency of CPP monitoring and ventilatory support applied to head-injured patients. ICP measurement disclosed a high rate of intracranial hypertension, which was not suspected in patients evaluated on a clinical basis alone. ICP monitoring was associated with a low rate of complications. Cases with severe neurological impairment, and with the worse outcome, were treated and monitored more intensively.
Stocchetti
N
N
Terapia Intensiva Neuroscienze, Serv. Anestesia e Rianimazione-Ospedale Policlinico IRCCS, Via Francesco Sforza 35, 20122 Milan, Italy. stocchet@polic.cilea.it
Penny
K I
KI
Dearden
M
M
Braakman
R
R
Cohadon
F
F
Iannotti
F
F
Lapierre
F
F
Karimi
A
A
Maas
A
A
Murray
G D
GD
Ohman
J
J
Persson
L
L
Servadei
F
F
Teasdale
G M
GM
Trojanowski
T
T
Unterberg
A
A
D000328:Adult; D000368:Aged; D002560:Cerebrovascular Circulation; D006259:Craniocerebral Trauma / Q000503:physiopathology / Q000628:therapy*; D003422:Critical Care; D005060:Europe; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000628:therapy; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D017063:Outcome Assessment, Health Care; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012121:Respiration, Artificial; D011795:Surveys and Questionnaires
D010100:Oxygen