Further experience in the management of severe head injury

Abstract

A prospective and consecutive series of 225 patients with severe head injuries who were managed in a uniform way was analyzed to relate outcome to several clinical variables. Good recovery or moderate disability were achieved by 56% of the patients, 10% remained severely disabled or vegetative, and 34% died. Factors important in predicting a poor outcome included the presence of intracranial hematoma, increasing age, abnormal motor responses, impaired or absent eye movements or pupil light reflexes, early hypotension, hypoxemia or hypercarbia, and elevation of intracranial pressure over 20 mm Hg despite artificial ventilation. Most of these predictive factors were assessed on admission, but a subset of 158 patients was identified in whom coma was present on admission and was known to have persisted at least until the following day. Although the mortality in this subset (40%) was higher than in the total series, it was lower than in several comparable reported series of patients with severe head injury. Predictive correlations were equally strong in the entire series and in the subset of 158 patients with coma. A plea is made for inclusion in the definition of "severe head injury" of all patients who do not obey commands or utter recognizable words on admission to the hospital after early resuscitation.

Hemotransfusion and mechanical ventilation time are associated with intra-hospital mortality in patients with traumatic brain injury admitted to intensive care unit

“…There was no correlation between the presence of systemic lesions associated with TBI and lethality resulting from TBI in this casuistic (p = 0.373), as also demonstrated by other studies 14,15,16 .…”

Cerebral autoregulation following minor head injury

“…[3,17,18,20] Information from the Traumatic Coma Data Bank indicates that lowered CPP resulting from hypotension or increased ICP is associated with a poor outcome following head injury. [3,17] Pietropaoli, et al, [27] also found that intraoperative hypotension occurring in severely head injured patients undergoing surgical procedures within 72 hours of admission to the hospital was associated with a significant increase in mortality rates and also a significant decrease in GOS scores compared to those seen in head-injured patients who did not become hypotensive during surgery.…”

The effects of erythropoietin and dextran and saline on brain edema and lipid peroxidation in experimental head trauma.

“…Although the results of these studies indicate that such patients may benefit from treatment with DS hypertonic solution, patients with head injury have not been included into these studies. [38] It has been shown that DS hypertonic solution reduces intracerebral pressure (ICP) in animals with head injury. Berger et al [39] have compared the ability of hypertonic DS with that of hypertonic mannitol to reduce intracranial hypertension that develop due to focal cerebral lesions and intracranial mass and have reported that hypertonic DS provides higher brain perfusion pressure than mannitol.…”