Indomethacin (Confortid) in severe head injury and elevated intracranial pressure (ICP)

In five head-injured patients with cerebral contusion and oedema in whom it was not possible to control ICP by hyperventilation and barbiturate sedation, indomethacin (Confortid) was used as a cerebral vasoconstrictor drug. In all patients indomethacin reduced ICP to below 20 mmHg for several hours. Studies of cerebral circulation and metabolism during indomethacin treatment showed a decrease in cerebral blood flow (CBF) at 2 hours. After 7 hours, ICP remained below 20 mmHg in three patients, and these still had reduced CBF. In two patients a return of ICP and CBF to pretreatment levels was observed. In all patients indomethacin treatment was followed by a fall in rectal temperature. Outcome scaling has not yet been performed, but all patients left hospital without neurological deficits. The results suggest, that indomethacin is an alternative in the treatment of ICP-hypertension in head-injured patients.