• S Naredi, E Edén, S Zäll, H Stephensen, and B Rydenhag.
• Department of Anesthesiology and Intensive Care, Institute of Surgical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden. Peter.Naredi@surgery.umu.se
• Intensive Care Med. 1998 May 1;24(5):446-51.

ObjectiveAnalysis of a standardized therapy focusing on prevention and treatment of vasogenic edema in patients suffering severe traumatic brain injury (TBI).DesignA retrospective analysis.SettingNeurointensive care unit at Sahlgrenska University Hospital, Göteborg, Sweden.Patients38 patients with severe TBI were included. The median Glasgow Coma Score was 5 (range 3-8) and median age 27 years (range 5-70 years).InterventionsMeasurement of intracranial pressure (ICP). Surgical evacuation of hematomas and contusions. Volume expansion aiming at normovolemia. Sedation with continuous intravenous infusion of low-dose thiopentone and reduction of stress response by clonidine. Normalization of capillary hydrostatic pressure by metoprolol and clonidine. If ICP and cerebral perfusion pressure (CPP) were not stabilized (ICP < 20 mmHg and CPP > 60 mm Hg), a continuous infusion of dihydroergotamine was added. In 4 patients a craniectomy was performed.ResultsOf the 38 patients, 27 (71%) survived with good recovery or moderate disability, 5 (13%) survived with severe disability, 1 (3%) remained in a vegetative state, and 5 (13%) died. The mortality due to intracranial hypertension was 11% (4 patients).ConclusionA therapy focusing on treatment of the assumed vasogenic edema in combination with aggressive neurosurgery resulted in an outcome as good as the best previously reported.

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