Intracranial hypertension in head injury

Management and results

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

Research output: Contribution to journalArticle

58 Citations (Scopus)

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

Fingerprint

Intracranial Hypertension
Craniocerebral Trauma
Intracranial Pressure
Cerebrovascular Circulation
Glasgow Coma Scale
Coma
Surgical Decompression
Hyperventilation
Pupil
Meningitis
Resuscitation
Teaching Hospitals
Hematoma
Observational Studies
Intensive Care Units
Arterial Pressure
Neck
Therapeutics
Head
Prospective Studies

Keywords

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

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Stocchetti, N., Rossi, S., Buzzi, F., Mattioli, C., Paparella, A., & Colombo, A. (1999). Intracranial hypertension in head injury: Management and results. Intensive Care Medicine, 25(4), 371-376. https://doi.org/10.1007/s001340050860

Intracranial hypertension in head injury : Management and results. / Stocchetti, N.; Rossi, S.; Buzzi, F.; Mattioli, C.; Paparella, A.; Colombo, A.

In: Intensive Care Medicine, Vol. 25, No. 4, 1999, p. 371-376.

Research output: Contribution to journalArticle

Stocchetti, N, Rossi, S, Buzzi, F, Mattioli, C, Paparella, A & Colombo, A 1999, 'Intracranial hypertension in head injury: Management and results', Intensive Care Medicine, vol. 25, no. 4, pp. 371-376. https://doi.org/10.1007/s001340050860
Stocchetti, N. ; Rossi, S. ; Buzzi, F. ; Mattioli, C. ; Paparella, A. ; Colombo, A. / Intracranial hypertension in head injury : Management and results. In: Intensive Care Medicine. 1999 ; Vol. 25, No. 4. pp. 371-376.
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