Abstract
Objective: Analysis of a standardized therapy focusing on prevention and treatment of vasogenic edema in patients suffering severe traumatic brain injury (TBI). Design: A retrospective analysis. Setting: Neurointensive care unit at Sahlgrenska University Hospital, Göteborg, Sweden. Patients: 38 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). Interventions: Measurement 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 mm Hg and CPP > 60 mm Hg), a continuous infusion of dihydroergotamine was added. In 4 patients a craniectomy was performed. Results: Of 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). Conclusion: A 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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Received: 15 July 1997 Accepted: 26 January 1998
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Naredi, S., Edén, E., Zäll, S. et al. A standardized neurosurgical/neurointensive therapy directed toward vasogenic edema after severe traumatic brain injury: clinical results. Intensive Care Med 24, 446–451 (1998). https://doi.org/10.1007/s001340050594
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DOI: https://doi.org/10.1007/s001340050594