Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 1998
Comparative StudyComparative effects of hypothermia, barbiturate, and osmotherapy for cerebral oxygen metabolism, intracranial pressure, and cerebral perfusion pressure in patients with severe head injury.
In order to select the optimal neurointensive treatment for patients with severe head injury and intracranial hypertension, the effects of hypothermia (HT), barbiturates (BT), and osmotic agents (OT) on focal and diffuse cerebral oxygen metabolism were evaluated by means of continuous monitoring of bifrontal regional oxygen saturation (rSO2), jugular bulb oxygen saturation (SjO2), jugular bulb temperature (Tjb), intracranial pressure (ICP), and cerebral perfusion pressure (CPP). ⋯ The therapeutic effects of hypothermia, barbiturates, and osmotherapy on cerebral oxygen metabolism and ICP/CPP are different according to the underlying pathological lesions of patients with severe head injury.
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Acta Neurochir. Suppl. · Jan 1998
Incidence of intracranial hypertension after severe head injury: a prospective study using the Traumatic Coma Data Bank classification.
Intracranial hypertension (ICH) is a frequent finding in patients with a severe head injury. High intracranial pressure (ICP) has been associated with certain computerized tomography (CT) abnormalities. The classification proposed by Marshall et al. based on CT scan findings, uses the status of the mesencephalic cisterns, the degree of midline shift, and the presence or absence of focal lesions to categorize the patients into different prognostic groups. Our aim in this study was to analyze the ICP evolution pattern in the different groups of lesions of this classification. ⋯ 3 patients had a normal CT scan, and none of them presented intracranial hypertension. In diffuse injury type II, the ICP evolution may be quite different. Patients with bilateral brain swelling (Diffuse Injury III) have a high risk of increased ICP (63.2%). Although in our study the frequency of Diffuse Injury IV was low, all patients in this category had a refractory ICP. In the category of evacuated mass lesions, two thirds of the patients presented an intracranial hypertension. In one third, ICP was refractory to treatment. 85% of patients with a non-evacuated mass lesion showed an increased ICP.
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Acta Neurochir. Suppl. · Jan 1998
Comparative StudyAn avoidable methodological failure in intracranial pressure monitoring using fiberoptic or solid state devices.
Failure of intraventricular pressure (IVP) measurement in case of catheter blockage is believed to be eliminated by using intraventricular microtransducers. We report about an avoidable methodological error, which may affect the reliability of IVP measurement with these devices. Intraventricular fiberoptic or solid state devices were implanted in 43 patients considered to be at risk for catheter occlusion. ⋯ In patients treated with Type B devices, no erroneous pressure recording could be identified, irrespective if CSF drainage was performed or not. Transducers, which are simply placed inside the ventriculostomy catheter require fluid coupling. They may fail, either during CSF drainage or when the catheter is blocked or placed within the parenchyma.
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Severe head injury with and without peripheral trauma is the most frequent cause of death and of severe disability up to 45 years. Outcome is determined by two major factors, the extent and nature of the irreversible primary brain damage, and the evolving secondary sequelae, which contrary to the former are responsive in principle to therapeutic intervention. An improvement of outcome from severe head injury can be expected only from an increased efficiency of the measures to prevent secondary brain damage. ⋯ Current results and experiences with establishment of this comprehensive research organization are presented, where no less than 31 hospitals. Institutions and organizations, and a study group of more than 40 physicians, students and statisticians are collaborating. Emerging data appear to be suitable to further improve pertinent aspects of the patient management as a basis to lower the incidence of secondary brain damage from severe head injury.
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Acta Neurochir. Suppl. · Jan 1998
Complications and safety associated with ICP monitoring: a study of 542 patients.
In our institution ICP was monitored in patients with GCS < or = 8 and abnormal CT scan: 362 severely head injured and 180 subarachnoid hemorrhage. Mean duration of monitoring was 103.6 hours (SD 74.96). Among 542 patients, 440 showed at least one episode of ICP above the threshold of 20 mm Hg. ⋯ In 13 cases (2.2%) a ventricular infection has been diagnosed. In 1 case an intraparenchimal hemorrhage related to the presence of the catheter was detected. Elevated risk of HICP and low incidence of complications have been shown in this series.