[Intensive care of patients in a coma following severe craniocerebral injury]

During last 14 years 748 patients in coma according to the Glasgow Coma Scale (scores less than 8) were treated at Neurosurgical intensive care unit. All the patients were mechanically ventilated. In 354 patients intracranial pressure (ICP) was monitored using Leeds boult. From 1990 arterial pressure was monitored invasively in all patients. According to ICP and cerebral perfusion pressure (CPP) we used mannitol and/or thipental, trying to keep ICP below 20 mmHg, and CPP at least near 65 mmHG. From 1992 we started also with arteriojugular oxygen saturation monitoring. According to narrow, normal or wide cerebral extraction of oxygen range so called optimized hyperventilation can be achieved. Despite mortality rate in patients with severe head injury is still high, aggressive intensive management can reduce it.