Intensive Care Medicine

, Volume 27, Issue 2, pp 400–406

Intensive care management of head-injured patients in Europe: a survey from the European Brain Injury Consortium

Authors

  • Nino Stocchetti
    • Terapia Intensiva Neuroscienze, Serv. Anestesia e Rianimazione-Ospedale Policlinico IRCCS, Via Francesco Sforza 35, 20122 Milan, Italy
  • Kay  I. Penny
    • Medical Statistics Unit, University of Edinburgh Medical School, Edinburgh, UK
  • Mark Dearden
    • Department of Anaethetics, Leeds General Infirmary, Leeds, UK
  • Reinder Braakman
    • Berkel Enschot, The Netherlands
  • François Cohadon
    • Department of Neurosurgery, Hôpital Pellegrin, Bordeaux, France
  • Fausto Iannotti
    • Department of Clinical Neurosciences, Southampton General Hospital, Southampton, UK
  • Françoise Lapierre
    • Centre Hospitalier Universitaire de Poitiers, Service de Neurochirurgie, Poitiers, France
  • Abbi Karimi
    • Neurochirurgische Klinik, Universität Köln, Cologne, Germany
  • Andrew Maas
    • Department of Neurosurgery, University Hospital Rotterdam, Rotterdam, The Netherlands
  • Gordon  D. Murray
    • Medical Statistics Unit, University of Edinburgh Medical School, Teviot Place, Edinburgh EH 89AG, UK
  • Juha Ohman
    • Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
  • Lennard Persson
    • Department of Neurosurgery, Akademiska Hospital, Uppsala, Sweden
  • Franco Servadei
    • Azienda USL Cesena, Ospedale M. Bufalini, Cesena, Italy
  • Graham  M. Teasdale
    • University Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
  • Tomasz Trojanowski
    • Department of Neurosurgery, University Medical School, Lublin, Poland
  • Andy Unterberg on behalf of the European Brain Injury Consortium
    • Department of Neurosurgery, Virchow-Klilnikum, Medizinische Fakultät, Humboldt Universität Berlin, Berlin, Germany
Original

DOI: 10.1007/s001340000825

Cite this article as:
Stocchetti, N., Penny, K. ., Dearden, M. et al. Intensive Care Med (2001) 27: 400. doi:10.1007/s001340000825

Abstract

Objectives: (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. Methods: 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. Results: 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. Conclusions: 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.

Head injury Intracranial pressure Cerebral perfusion pressure Artificial ventilation Outcome Intensive care
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© Springer-Verlag 2000