Intensive care management of head-injured patients in Europe: A survey from the European brain injury consortium

Nino Stocchetti, Kay I. Penny, Mark Dearden, Reinder Braakman, François Cohadon, Fausto Iannotti, Françoise Lapierre, Abbi Karimi, Andrew Maas, Gordon D. Murray, Juha Ohman, Lennard Persson, Franco Servadei, Graham M. Teasdale, Tomasz Trojanowski, Andy Unterberg

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: (a) to describe current practice in the monitoring and treatment of moderate and severe head injuries in Europe; (b) to report on intracranial pressure and cerebral perfusion pressure monitoring, occurrence of measured and reported intracranial hypertension, and complications related to this monitoring; (c) to investigate the relationship between the severity of injury, the frequency of monitoring and management, and outcome. Methods: A three-page questionnaire comprising 60 items of information has been compiled by 67 centres in 12 European countries. Information was collected prospectively regarding all severe and moderate head injuries in adults (> 16 years) admitted to neurosurgery within 24 h of injury. A total of 1005 adult head injury cases were enrolled in the study from 1 February 1995 to 30 April 1995. The Glasgow Outcome Scale was administered at 6 months. Results: Early surgery was performed in 346 cases (35%); arterial pressure was monitored invasively in 631 (68%), ICP in 346 (37%), and jugular bulb saturation in 173 (18%). Artificial ventilation was provided to 736 patients (78%). Intracranial hypertension was noted in 55% of patients in whom ICP was recorded, while it was suspected in only 12% of cases without ICP measurement. There were great differences in the use of ventilation and CPP monitoring among the centres. Mortality at 6 months was 31%. There was an association between an increased frequency of monitoring and intervention and an increased severity of injury; correspondingly, patients who more frequently underwent monitoring and ventilation had a less favourable outcome. Conclusions: In Europe there are great differences between centres in the frequency of CPP monitoring and ventilatory support applied to head-injured patients. ICP measurement disclosed a high rate of intracranial hypertension, which was not suspected in patients evaluated on a clinical basis alone. ICP monitoring was associated with a low rate of complications. Cases with severe neurological impairment, and with the worse outcome, were treated and monitored more intensively.

Original languageEnglish
Pages (from-to)400-406
Number of pages7
JournalIntensive Care Medicine
Volume27
Issue number2
DOIs
Publication statusPublished - 2001

Keywords

  • Artificial ventilation
  • Cerebral perfusion pressure
  • Head injury
  • Intensive care
  • Intracranial pressure
  • Outcome

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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