title: ICP threshold in CPP management of severe head injury patients.
abstract: BACKGROUND
  Elevated intracranial pressure (ICP) is significantly associated with high mortality rate in severe head injury (SHI) patients. However, there is no absolute agreement regarding the level at which ICP must be treated. The objective of this study was to compare the outcomes of severe head injury patients treated by setting the ICP threshold at >or=20 mm Hg or >or=25 mm Hg.
  
  
  METHODS
  Treatment protocol in this study consisted of therapeutic maneuvers designed to maximize cerebral profusion pressure (CPP) and control ICP. Twenty-seven patients with severe head injury and intracranial hypertension (ICP >or=20 mm Hg) were enrolled and fourteen cases were allocated to the group of ICP threshold >or=25 mm Hg. Six-month clinical outcomes were evaluated using the Glasgow Outcome Score (GOS).
  
  
  RESULTS
  There were no statistically significant differences in clinical parameters between the groups. Logistic regression identified the presence of basal cisterns on the initial computed tomography (CT) scan as a significant predictor of good outcome. ICP threshold did not influence outcome.
  
  
  CONCLUSIONS
  This study supported a recommended ICP threshold of 20 to 25 mm Hg in SHI management. However, in cases with an absence of basal cisterns on initial CT scan, the probability of good outcome may be higher using an ICP threshold of >or=20 mm Hg.
authors.affiliation: Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
authors.forename: Sanguansin
authors.initials: S
authors.lastname: Ratanalert
authors.forename: Nakornchai
authors.initials: N
authors.lastname: Phuenpathom
authors.forename: Sakchai
authors.initials: S
authors.lastname: Saeheng
authors.forename: Thakul
authors.initials: T
authors.lastname: Oearsakul
authors.forename: Boonlert
authors.initials: B
authors.lastname: Sripairojkul
authors.forename: Siriporn
authors.initials: S
authors.lastname: Hirunpat
mesh_terms: D000328:Adult; D000465:Algorithms; D001921:Brain / Q000098:blood supply*; D020202:Cerebral Hemorrhage, Traumatic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D003131:Combined Modality Therapy; D006259:Craniocerebral Trauma / Q000150:complications* / Q000175:diagnosis; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D015600:Glasgow Coma Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology* / Q000628:therapy*; D008353:Mannitol / Q000627:therapeutic use; D010100:Oxygen / Q000627:therapeutic use; D011446:Prospective Studies
chemical_list: D004234:Diuretics, Osmotic; D008353:Mannitol; D010100:Oxygen