Intracranial hypertension in head injury: Management and results

N. Stocchetti, S. Rossi, F. Buzzi, C. Mattioli, A. Paparella, A. Colombo

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: (1) To describe the pattern of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in a group of severe head-injured patients, (2) to quantify complications of ICP monitoring, and (3) to describe a management protocol and its results. Design: Prospective observational study. Setting: General intensive care unit in a teaching hospital. Patients: 138 comatose patients, selected according to the following criteria: age > 16 years, coma [Glasgow Coma Scale (GCS) ≤ 8] with at least one pupil reactive after resuscitation, digital recording of intracranial and arterial pressure, and jugular saturation measurements. Measurements and results: Median GCS was 5, and 62 patients had significant extracranial injuries; 71 had intracranial hematomas, which were urgently evacuated. Mean ICP was 20.5 mm Hg (SD 8.34), mean CPP was 71.86 mm Hg (SD 11.22); cerebral extraction of oxygen averaged 29%. Medical therapy was used to control ICP in 130 cases: 93 patients required hyperventilation. Vasopressors were infused in 16 cases; in 14 cases a barbiturate infusion was started. In 6 patients all pharmacological treatments failed and surgical decompression was done. The only complication of ICP monitoring was meningitis in 3 patients. Outcome at 6 months was a good recovery and moderate disability for 82 patients (59.4%), severe disability and vegetative status for 37 (26.8%), and 19 patients died (13.7%). The severity of intracranial hypertension was related to poorer results at 6 months. Conclusions. Intracranial hypertension is very frequent in severe head injury but can be reasonably well controlled by combined surgical and medical therapy.

Original languageEnglish
Pages (from-to)371-376
Number of pages6
JournalIntensive Care Medicine
Volume25
Issue number4
DOIs
Publication statusPublished - 1999

Keywords

  • Cerebral extraction of oxygen
  • Cerebral perfusion pressure
  • Head injury
  • Intracranial pressure
  • Outcome

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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