High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury

J Neurosurg. 1988 Jul;69(1):15-23. doi: 10.3171/jns.1988.69.1.0015.


In a five-center study, 73 patients with severe head injury and elevated intracranial pressure (ICP) were randomly assigned to receive either a regimen that included high-dose pentobarbital or one that was otherwise similar but did not include pentobarbital. The results indicated a 2:1 benefit for those treated with the drug with regard to ICP control. When patients were stratified by prerandomization cardiac complications, the advantage increased to 4:1. A multiple logistic model considering treatment and selected baseline variables indicated a significant positive treatment effect of barbiturates, a significant effect of time from injury to randomization, and an interaction of treatment with cardiovascular complications. However, of 925 patients potentially eligible for randomization, only 12% met ICP randomization criteria. The results support the hypothesis that high-dose pentobarbital is an effective adjunctive therapy, but that it is indicated in only a small subset of patients with severe head injury.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Clinical Trials as Topic
  • Coma / physiopathology
  • Humans
  • Intracranial Pressure / drug effects*
  • Middle Aged
  • Models, Theoretical
  • Pentobarbital / administration & dosage*
  • Pentobarbital / adverse effects
  • Pentobarbital / therapeutic use
  • Prognosis
  • Random Allocation
  • Severity of Illness Index


  • Pentobarbital