Prognosis for patients with severe brain injuries

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Intraventricular pressure recording is a standard neurosurgical procedure.
• 250 recordings were performed, with 90 on brain-injured patients, up to December 1970.
• Intraventricular pressure correlates with survival but not the quality of survival.

Purpose of the Study:

• To identify criteria that correlate with the quality of survival in brain-injured patients.
• To evaluate prognostic indicators for vegetative survival.
• To inform decisions regarding intensive therapy for severely brain-injured patients.

Main Methods:

• Prospective study of 50 patients from January 1967 to December 1969.
• Monitoring of intraventricular pressure.
• Assessment of clinical signs including arterial carbon dioxide levels, respiratory minute volume, body temperature, breathing patterns, and motor responses.

Main Results:

• Intraventricular pressure correlates with patient survival or death.
• Specific clinical indicators suggest vegetative survival: low arterial PCO2, high respiratory minute volume, fever (>39°C), Cheyne-Stokes respiration, and extension rigidity.
• These findings may question the extent of intensive therapy in cases of poor prognosis.

Conclusions:

• While intraventricular pressure predicts survival, other clinical signs are crucial for predicting the quality of survival.
• Identifying patients likely to have a vegetative survival can guide therapeutic intensity.
• Careful consideration of prognosis is essential when allocating intensive care resources.