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- Title
Intensive care management of head-injured patients in Europe: a survey from the European brain injury consortium.
- Authors
Stocchetti, Nino; Penny, Kay I.; Dearden, Mark; Braakman, Reinder; Cohadon, François; Iannotti, Fausto; Lapierre, Françoise; Karimi, Abbi; Maas, Andrew; Murray, Gordon D.; Ohman, Juha; Persson, Lennard; Servadei, Franco; Teasdale, Graham M.; Trojanowski, Tomasz; Unterberg, Andy; Stocchetti, N; Penny, K I; Dearden, M; Braakman, R
- Abstract
<bold>Objectives: </bold>(a) to describe current practice in the monitoring and treatment of moderate and severe head injuries in Europe; (b) to report on intracranial pressure and cerebral perfusion pressure monitoring, occurrence of measured and reported intracranial hypertension, and complications related to this monitoring; (c) to investigate the relationship between the severity of injury, the frequency of monitoring and management, and outcome.<bold>Methods: </bold>A three-page questionnaire comprising 60 items of information has been compiled by 67 centres in 12 European countries. Information was collected prospectively regarding all severe and moderate head injuries in adults (> 16 years) admitted to neurosurgery within 24 h of injury. A total of 1005 adult head injury cases were enrolled in the study from 1 February 1995 to 30 April 1995. The Glasgow Outcome Scale was administered at 6 months.<bold>Results: </bold>Early surgery was performed in 346 cases (35%); arterial pressure was monitored invasively in 631 (68%), ICP in 346 (37%), and jugular bulb saturation in 173 (18%). Artificial ventilation was provided to 736 patients (78%). Intracranial hypertension was noted in 55% of patients in whom ICP was recorded, while it was suspected in only 12% of cases without ICP measurement. There were great differences in the use of ventilation and CPP monitoring among the centres. Mortality at 6 months was 31%. There was an association between an increased frequency of monitoring and intervention and an increased severity of injury; correspondingly, patients who more frequently underwent monitoring and ventilation had a less favourable outcome.<bold>Conclusions: </bold>In Europe there are great differences between centres in the frequency of CPP monitoring and ventilatory support applied to head-injured patients. ICP measurement disclosed a high rate of intracranial hypertension, which was not suspected in patients evaluated on a clinical basis alone. ICP monitoring was associated with a low rate of complications. Cases with severe neurological impairment, and with the worse outcome, were treated and monitored more intensively.
- Subjects
EUROPE; CRITICAL care medicine; MEDICAL care; PUBLIC health; MEDICINE; INTRACRANIAL pressure; CEREBROSPINAL fluid pressure
- Publication
Intensive Care Medicine, 2001, Vol 27, Issue 2, p400
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s001340000825