[The limits of intensive care in craniocerebral trauma]

Cerebral lesions of variable severity lead to systemic and intracranial reactions. These create secondary brain damage due to hypoxia and ischemia. The causes as well as the sequelae of secondary brain damage necessitate long-term intensive care treatment with high technical and personal expenditure. This expensive treatment, however, remains unsuccessful in a large number of patients. 60% to 70% of the lethal courses following head trauma are found during the first 2 to 3 days. In those cases which succumb after weeks or less frequently after months in spite of intensive care treatment, the question of early limitation of intensive care seems reasonable. However, only a reliable early prediction of the unfavorable outcome can justify the limitation of unsuccessful intensive care treatment. Early prediction with respect to survival or lethal course is usually possible within the first two weeks following trauma. The early prediction with respect to later disability however is highly limited during the acute phase. The decision to limit treatment should be based on the numerous national and international statistical models and discussed on an individual basis, excluding even a 5% chance of survival. Early information of the family on the probable prognosis is useful. Their participation in the process of decision can be assessed only on an individual basis.