Neurologic outcome of posttraumatic refractory intracranial hypertension treated with external lumbar drainage.
BACKGROUND
Refractory intracranial hypertension (ICH) to second level measures after severe traumatic brain injury (TBI) is associated with mortality up to 84% to 100%. The use of external lumbar drainage (ELD) has been described in these patients. We report our experience with the use of ELD in 17 cases of refractory ICH after severe TBI.


METHODS
In our Level 3 Intensive Care Unit (ICU) at a university hospital, ICH is treated according to a progressive approach following the Brain Trauma Foundation guidelines. When second level measures fail to control ICH, we use an ELD as a rescue therapy if basal cisterns are discernible. Outcome at ICU discharge and 6 months after injury were analyzed using Glasgow Outcome Scale (GOS).


RESULTS
Mean age was 32.5 +/- 13.3 years. ICH was reduced in all patients. ICP before ELD was 30.9 +/- 7.9 mm Hg and after ELD 14.1 +/- 5.9 mm Hg. Four patients (24%) had an ICH rebound after 5 days of ELD placement and died in the ICU. At 6 months after TBI, 13 patients (76%) presented a good outcome (GOS score of 4 and 5). No patient presented pupillary changes or cerebrospinal fluid infection during ELD use.


CONCLUSIONS
External lumbar drainage is an effective and safe procedure to treat refractory ICH when basal cisterns are discernible. Control of refractory ICH with ELD is associated with an important reduction of mortality and a good functional recovery at 6 months.
Abadal-Centellas
Josep M
JM
Servicio de Medicina Intensiva, Hospital Universitario Son Dureta, Palma de Mallorca, Spain.
Llompart-Pou
Juan A
JA
Homar-Ramírez
Javier
J
Pérez-Bárcena
Jon
J
Rosselló-Ferrer
Ainhoa
A
Ibáñez-Juvé
Jordi
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications*; D002555:Cerebrospinal Fluid; D004322:Drainage / Q000379:methods*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D019586:Intracranial Hypertension / Q000209:etiology / Q000628:therapy*; D007427:Intracranial Pressure; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome