Abstract | OBJECTIVE: : Intracranial hypertension after severe head injury is associated with case fatality, but there is no sound evidence that monitoring of intracranial pressure (ICP) and targeted management of cerebral perfusion pressure ( CPP) improve outcome, despite widespread recommendation by experts in the field. The purpose was to determine the effect of ICP/ CPP-targeted intensive care on functional outcome and therapy intensity levels after severe head injury. DESIGN: : Retrospective cohort study with prospective assessment of outcome. SETTING: : Two level I trauma centers in The Netherlands from 1996 to 2001. PATIENTS: : Three hundred thirty-three patients who had survived and remained comatose for >24 hrs, from a total of 685 consecutive severely head-injured adults. INTERVENTIONS: : In center A (supportive intensive care), mean arterial pressure was maintained at approximately 90 mm Hg, and therapeutic interventions were based on clinical observations and computed tomography findings. In center B (ICP/ CPP-targeted intensive care), management was aimed at maintaining ICP <20 mm Hg and CPP >70 mm Hg. Allocation to either trauma center was solely based on the site of the accident. MEASUREMENTS AND MAIN RESULTS: : We measured extended Glasgow Outcome Scale after >/=12 months. Patient characteristics were well balanced between the centers. ICP monitoring was used in zero of 122 (0%) and 142 of 211 (67%) patients in centers A and B, respectively. In-hospital mortality rate was 41 (34%) vs. 69 (33%; p = .87). The odds ratio for a more favorable functional outcome following ICP/ CPP-targeted therapy was 0.95 (95% confidence interval, 0.62-1.44). This result remained after adjustment for potential confounders. Sedatives, vasopressors, mannitol, and barbiturates were much more frequently used in center B (all p < .01). The median number of days on ventilator support in survivors was 5 (25th-75th percentile, 2-9) in center A vs. 12 (7-19) in center B (p < .001). CONCLUSIONS:
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Authors | Olaf L Cremer, Gert W van Dijk, Erik van Wensen, Geert J F Brekelmans, Karel G M Moons, Loek P H Leenen, Cor J Kalkman |
Journal | Critical care medicine
(Crit Care Med)
Vol. 33
Issue 10
Pg. 2207-13
(Oct 2005)
ISSN: 0090-3493 [Print] United States |
PMID | 16215372
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Adult
- Blood Pressure
(physiology)
- Brain Injuries
(physiopathology, therapy)
- Cerebrovascular Circulation
(physiology)
- Cohort Studies
- Critical Care
(methods)
- Female
- Humans
- Intracranial Pressure
(physiology)
- Length of Stay
- Male
- Middle Aged
- Monitoring, Physiologic
- Recovery of Function
- Retrospective Studies
- Treatment Outcome
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