Severe traumatic brain injury: management and prognosis

The aim of the study is to assess the efficacy of early treatment in severe traumatic brain injury by evaluating patients' survival and functional recovery.

We subdivided 184 patients into 2 groups (Group A: patients admitted to hospital within the first hour of injury; Group B: patients admitted after the first hour of injury). In order to maintain the mean arterial pressure (MAP) >90 with cerebral perfusion pressure (CPP) >70 mmHg, we used plasma expanders; in 76 patients with MAP >90 mmHg, we administered dopamine, and in 5 cases noradrenaline. In 157 patients we used mechanical ventilation (MV). For orotracheal intubation and sedation/analgesia, we administered: propofol (a bolus of 2 mg/kg+1 mg/kg/h)+midazolam (0.03 mg/kg/h) + cisatracurium besilate (0.2 mg/kg) in 113 patients, or thiopentone sodium (a bolus of 4 mg/kg + 1-2 mg/kg/h)+cisatracurium besilate (0.2 mg/kg) in 44 patients with endocranial hypertension without bleeding and convulsions. After muscle relaxation we administered remifentanyl (0.075 microg/kg/min). Surgical decompression was performed in 57 cases. Data were analysed with Student's t-test.

The number of deaths was significantly lower in Group A (P<0.05): 9 patients from Group A and 21 patients from Group B died within 24 h (P<0.05), while 15 patients from Group A and 16 patients from Group B died after the first 24 h period. After the recovery of critical life functions, 53 patients from Group A and 34 patients from Group B were transferred to a medical ward (P<0.0001), while 15 patients from Group A and 21 patients from Group B were transferred to a rehabilitation facility (P<0.05).

Prevention, early treatment of complications and maintenance of homeostasis lead to a better prognosis in terms of survival, functional recovery and to a reduction in economic and social costs.