title: Intensive care and traumatic brain injury after the introduction of a treatment protocol: a prospective study.
abstract: BACKGROUND
  Traumatic brain injury (TBI) treatment protocols have been introduced in the intensive care unit (ICU) to avoid secondary brain injury. In this study, we aimed to evaluate the deviations from such a treatment protocol and the frequency of extracranial complications, and relate these findings to outcome.
  
  
  METHODS
  During a 5-year period (2004-2009), 133 patients with severe TBI [Glasgow Coma Scale (GCS) score ≤ 8] were prospectively included. The following deviations from treatment goals were studied: intracranial pressure (ICP), blood pressure, haemoglobin, blood glucose, serum sodium, serum albumin, body temperature and extracranial complications during the ICU stay. Outcome was assessed using Glasgow Outcome Scale Extended score at 12 months.
  
  
  RESULTS
  The frequencies of deviations from the treatment goals were: episodes of intracranial hypertension 69.5% (of monitored patients), hypotension 20.3%, anaemia 77.4%, hyperglycaemia 42.9%, hyponatremia 34.6%, hypoalbuminemia 30.8% and hyperthermia 54.9%. Pulmonary complications were common (pneumonia 72.2%, acute respiratory distress syndrome/acute lung injury 31.6%). Thrombocytopenia (4.5%), severe sepsis (3.0%), renal failure (0.8%) and liver failure (0.8%) were infrequent. Twenty-six (19.5%) patients died within the first 12 months due to the head injury. Age, GCS score, pupil dilation, Injury Severity Score (ISS), ICP > 25 mmHg, hyperglycaemia and pneumonia predicted a worse outcome.
  
  
  CONCLUSIONS
  Deviations from the TBI treatment protocol were frequent. Pneumonia was the most frequent extracranial complication. Age, GCS score, pupil dilation, ISS, high ICP, hyperglycaemia and pneumonia predicted a worse outcome.
authors.affiliation: Department of Anaesthesia and Acute Medicine, St.Olav University Hospital, Trondheim, Norway. kari.schirmer@stolav.no
authors.forename: K
authors.initials: K
authors.lastname: Schirmer-Mikalsen
authors.forename: K G
authors.initials: KG
authors.lastname: Moen
authors.forename: T
authors.initials: T
authors.lastname: Skandsen
authors.forename: A
authors.initials: A
authors.lastname: Vik
authors.forename: P
authors.initials: P
authors.lastname: Klepstad
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006040:Goals; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D019586:Intracranial Hypertension / Q000209:etiology / Q000628:therapy; D007427:Intracranial Pressure; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000628:therapy; D009104:Multiple Trauma / Q000150:complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult