A standardized neurosurgical neurointensive therapy directed toward vasogenic edema after severe traumatic brain injury: clinical results.

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 mmHg 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.