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 language | English |
|---|---|
| Pages (from-to) | 371-376 |
| Number of pages | 6 |
| Journal | Intensive Care Medicine |
| Volume | 25 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 1999 |
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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
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 journal › Article
}
TY - JOUR
T1 - Intracranial hypertension in head injury
T2 - Management and results
AU - Stocchetti, N.
AU - Rossi, S.
AU - Buzzi, F.
AU - Mattioli, C.
AU - Paparella, A.
AU - Colombo, A.
PY - 1999
Y1 - 1999
N2 - 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.
AB - 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.
KW - Cerebral extraction of oxygen
KW - Cerebral perfusion pressure
KW - Head injury
KW - Intracranial pressure
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=0032938262&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0032938262&partnerID=8YFLogxK
U2 - 10.1007/s001340050860
DO - 10.1007/s001340050860
M3 - Article
C2 - 10342510
AN - SCOPUS:0032938262
VL - 25
SP - 371
EP - 376
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 4
ER -