The effect of barbiturate coma therapy for the patients with severe intracranial hypertension: a 10-year experience.
OBJECTIVE
Barbiturate coma therapy (BCT) has been known to be an useful method to control increased intracranial pressure (IICP) refractory to medical and surgical treatments. We have used BCT for patients with severe IICP during the past 10 years, and analyzed our results with review of literatures.


METHODS
We analyzed 92 semicomatose or comatose patients with Glasgow coma scale (GCS) of 7 or less with severe IICP due to cerebral edema secondary to parenchymal damages irrespective of their causes. Forty patients who had received BCT with ICP monitoring from January 1997 to December 2006 were included in BCT group, and fifty-two patients who had been managed without BCT from January 1991 to December 1995 were divided into control group. We compared outcomes with Glasgow outcome scale (GOS) and survival rate between the two groups.


RESULTS
Good outcome (GOS=4 and 5) rates at 3-month after insult were 27.5% and 5.8% in BCT and control group, respectively (p<0.01). One-year survival rates were 35.9% and 12.5% in BCT and control group, respectively (p<0.01). In BCT group, the mean age of good outcome patients (37.1 +/- 14.9) was significantly lower than that of poor outcome patients (48.1 +/- 13.5) (p<0.05).


CONCLUSIONS
With our 10-year experience, we suggest that BCT is an effective treatment method for severe IICP patients for better survival and GOS, especially for younger patients.
Kim
Young-Il
YI
Department of Neurological Surgery, Chung-Ang University Yongsan Hospital, Seoul, Korea.
Park
Seung-Won
SW
Nam
Taek-Kyun
TK
Park
Yong-Sook
YS
Min
Byung-Kook
BK
Hwang
Sung-Nam
SN