[Early aggressive treatment in severe craniocerebral injuries]

A series of 33 severely head injured patients, Glasgow Coma Scala score 8 or less, was studied prospectively. All patients were treated by the same protocols and by the physician. Intracranial pressure was monitored in all patients by ventricular puncture. Some degree of increased intracranial pressure (more than 10mmHg) was present at admission to the intensive care unit in 52% of cases. Increases in over 20mmHg during the monitoring period were seen in 15 patients (45%). In 5 patients (15%) he was over 20mmHg, but controlled in intensive care unit with combination of dexamethasone, hyperventilation, normothermia, furosemide and mannitol. In this group mortality rate was 80%. In 10 patients (30%) intracranial hypertension was uncontrollable despite intensive measures, in this group all patients died. The mortality rate in patients with intracranial pressure less than 20mmHg during the monitoring period was significantly lower, 25%. Uncontrollable intracranial hypertension is a serious prognostic sign; all affected patients in our series died. Even intracranial pressure more than 20mmHg, which could be controlled, was associated with high mortality rate (80%). By early aggressive treatment based on intracranial pressure monitoring we can diminish the incidence of intracranial hypertension and reduce overall mortality rate in patients with severe head injury.