Severe traumatic brain injury in Austria IV: intensive care management.
OBJECTIVE
The goal of this paper is to describe the ICU management of severe traumatic brain injury (TBI) in Austria.


METHODS
Data sets from 415 patients included by 5 Austrian hospitals were available. The analysis focused on complications and outcomes of intensive care, monitoring of intracranial pressure (ICP), efficacy of interventions to control ICP, management of hemodynamics and cerebral perfusion pressure (CPP), ventilation, and effects of hyperglycaemia.


RESULTS
Overall ICU mortality was 30.8%; 90-day mortality was 35.7%. Final outcome was favorable in 33%, unfavorable in 51%, and in 16% the final outcome was unknown. An ICP monitoring device was used in 64%; most patients received intraparenchymal sensors (77%). Events associated with mortality > 50% were CPP < 50 mm Hg for > 12 hours/day, ICP > 25 mm Hg for > 12 hours/day, and MAP < 70 mm Hg for > 18 hours/day. The use of ICP monitoring was associated with significantly reduced ICU mortality. Interventions that may have improved the outcome included the use of barbiturates (short-term), hypertonic saline, moderate hyperventilation (33 < pCO2 < 37; p < 0.001 vs. aggressive hyper-and normoventilation), and normothermia. Hyperglycaemia was associated with poor outcome.


CONCLUSIONS
Our study showed that ICU management of patients with severe TBI mostly follows international guidelines, and that outcome was comparable to or even better than that reported by other authors. Low CPP was associated with poor outcome, and was more often due to low MAP than to elevated ICP. The use of barbiturates and hypertonic saline was more common than expected. CPP should be maintained > 50 mm Hg, the use of catecholamines, fluid loading, barbiturates (short-term), moderate hyperventilation, hypertonic saline, and insulin may improve outcome after severe TBI.
Mauritz
Walter
W
Department of Anaesthesia and Critical Care Medicine, Trauma Hospital Lorenz Boehler, INRO (International Neurotrauma Research Organisation) Medical Advisory Board, Vienna, Austria. walter.mauritz@igeh.org
Janciak
Ivan
I
Wilbacher
Ingrid
I
Rusnak
Martin
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000098:blood supply; D001930:Brain Injuries / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D006339:Heart Rate / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D007223:Infant; D019586:Intracranial Hypertension / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011379:Prognosis; D012121:Respiration, Artificial; D016019:Survival Analysis