[The prognostic value of various intensive medicine parameters in long-term intubated neurosurgical patients]

The prognosis of 1693 patients of the intensive care unit of the Neurochirurgische Universitätsklinik Bonn was investigated. They all required intubation and mechanical ventilation, 912 of them for more than 24 hours (prolonged intubation). The overall mortality rate was 25.3%, while in cases with prolonged intubation it was 41%. No valid conclusion could be drawn from the duration of intubation as to survival. Next to the primary disease which was most important, the patient's age was of great prognostic value. Pneumonia (16% incidence) and prerenal failure (14.9%) seemed to be of minor importance, whereas renal failure (16.6%) worsened prognosis considerably by a mortality of 71-100%. Dexamethasone therapy proved to be of advantage in the management of brain tumors. No influence on the outcome of patients with severe head injury was seen. Patients with cerebrovascular disease were detrimentally affected by corticosteroid administration. Apart from extreme situations there were no satisfying predictors of outcome by means of which one could preselect patients to enter intensive care units. The decision to eventually withdraw life support can only be made on the basis of numerous factors.