ICP threshold in CPP management of severe head injury patients.
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.
Ratanalert
Sanguansin
S
Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Phuenpathom
Nakornchai
N
Saeheng
Sakchai
S
Oearsakul
Thakul
T
Sripairojkul
Boonlert
B
Hirunpat
Siriporn
S
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
D004234:Diuretics, Osmotic; D008353:Mannitol; D010100:Oxygen