Intensive care management of head-injured patients in Europe: a survey from the European brain injury consortium

Intensive Care Med. 2001 Feb;27(2):400-6. doi: 10.1007/s001340000825.

Abstract

Objectives: (a) to describe current practice in the monitoring and treatment of moderate and severe head injuries in Europe; (b) to report on intracranial pressure and cerebral perfusion pressure monitoring, occurrence of measured and reported intracranial hypertension, and complications related to this monitoring; (c) to investigate the relationship between the severity of injury, the frequency of monitoring and management, and outcome.

Methods: A three-page questionnaire comprising 60 items of information has been compiled by 67 centres in 12 European countries. Information was collected prospectively regarding all severe and moderate head injuries in adults (> 16 years) admitted to neurosurgery within 24 h of injury. A total of 1005 adult head injury cases were enrolled in the study from 1 February 1995 to 30 April 1995. The Glasgow Outcome Scale was administered at 6 months.

Results: Early surgery was performed in 346 cases (35%); arterial pressure was monitored invasively in 631 (68%), ICP in 346 (37%), and jugular bulb saturation in 173 (18%). Artificial ventilation was provided to 736 patients (78%). Intracranial hypertension was noted in 55% of patients in whom ICP was recorded, while it was suspected in only 12% of cases without ICP measurement. There were great differences in the use of ventilation and CPP monitoring among the centres. Mortality at 6 months was 31%. There was an association between an increased frequency of monitoring and intervention and an increased severity of injury; correspondingly, patients who more frequently underwent monitoring and ventilation had a less favourable outcome.

Conclusions: In Europe there are great differences between centres in the frequency of CPP monitoring and ventilatory support applied to head-injured patients. ICP measurement disclosed a high rate of intracranial hypertension, which was not suspected in patients evaluated on a clinical basis alone. ICP monitoring was associated with a low rate of complications. Cases with severe neurological impairment, and with the worse outcome, were treated and monitored more intensively.

MeSH terms

  • Adult
  • Aged
  • Cerebrovascular Circulation
  • Craniocerebral Trauma / physiopathology
  • Craniocerebral Trauma / therapy*
  • Critical Care*
  • Europe
  • Female
  • Glasgow Coma Scale
  • Humans
  • Intracranial Hypertension / diagnosis
  • Intracranial Hypertension / therapy
  • Intracranial Pressure
  • Male
  • Middle Aged
  • Monitoring, Physiologic
  • Outcome Assessment, Health Care
  • Oxygen / blood
  • Prospective Studies
  • Respiration, Artificial
  • Surveys and Questionnaires

Substances

  • Oxygen