[Possibilities and limitations of intensive therapy in severe craniocerebral injuries]

In a retrospective, non-randomised study, the author examined the influence of additional drug treatment on the prognosis of severe injuries of the skull and brain. The emphasis of this study was on treatment with dexamethasone and barbiturates. Of 489 injured persons, 260 were treated with dexamethasone and 229 by the conventional standard treatment method only. Evaluation of the results showed that the high-dosage dexamethasone therapy clearly reduced the mortality in severe injuries of the skull and brain (from 57.4% to 32.4%), although this partly resulted in an increase of defective conditions. On the other hand, no definite effect of treatment was noticeable in extremeLy severe cases with high-grade substantial brain damage and with the milder forms of trauma in which the traumatic brain oedema did not play a prominent role. Barbiturates were used only where it proved impossible to reduce the increased brain pressure by other means. Good remissions were seen in some patients, but the total number is insufficient for a final evaluation. Independent of the treatment, however, other factors (depth and duration of the initial disturbance of consciousness, age, concomitant injuries) exercise a significant influence on the prognosis of severe injuries of the skull and brain.