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.
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.
Authors: Randall M Chesnut; Nancy Temkin; Walter Videtta; Gustavo Petroni; Silvia Lujan; Jim Pridgeon; Sureyya Dikmen; Kelley Chaddock; Jason Barber; Joan Machamer; Nahuel Guadagnoli; Peter Hendrickson; Sergio Aguilera; Victor Alanis; Manuel Enrique Bello Quezada; Ermitaño Bautista Coronel; Luis Alberto Bustamante; Armando C Cacciatori; Carlos Javier Carricondo; Felipe Carvajal; Rafael Davila; Mario Dominguez; Jairo Antonio Figueroa Melgarejo; Maria Martha Fillipi; Daniel A Godoy; Delia Cristina Gomez; Angel J Lacerda Gallardo; Juan Antonio Guerra Garcia; Gustavo la Fuente Zerain; Luis Arturo Lavadenz Cuientas; Cecilio Lequipe; Gerardo Vicente Grajales Yuca; Manuel Jibaja Vega; Michael Eduardo Kessler; Hubiel J López Delgado; Freddy Sandi Lora; Ana Maria Mazzola; Roberto Merida Maldonado; Natascha Mezquia de Pedro; J Ricardo Martínez Zubieta; Julio C Mijangos Méndez; Jacobo Mora; Johnny Marcelo Ochoa Parra; Perla B Pahnke; Jorge Paranhos; Gustavo R Piñero; Francisco A Rivadeneira Pilacuán; Mario Napoleon Mendez Rivera; Ricardo Luis Romero Figueroa; Andres M Rubiano; Alexandra Matilde Saraguro Orozco; Juan Ignacio Silesky Jiménez; Luis Silva Naranjo; Caridad Soler Morejon; Zulma Urbina Journal: J Neurotrauma Date: 2020-03-04 Impact factor: 5.269
Authors: Randall M Chesnut; Nancy Temkin; Nancy Carney; Sureyya Dikmen; Carlos Rondina; Walter Videtta; Gustavo Petroni; Silvia Lujan; Jim Pridgeon; Jason Barber; Joan Machamer; Kelley Chaddock; Juanita M Celix; Marianna Cherner; Terence Hendrix Journal: N Engl J Med Date: 2012-12-12 Impact factor: 91.245
Authors: Randall M Chesnut; Nancy Temkin; Sureyya Dikmen; Carlos Rondina; Walter Videtta; Gustavo Petroni; Silvia Lujan; Victor Alanis; Antonio Falcao; Gustavo de la Fuenta; Luis Gonzalez; Manuel Jibaja; Arturo Lavarden; Freddy Sandi; Roberto Mérida; Ricardo Romero; Jim Pridgeon; Jason Barber; Joan Machamer; Kelley Chaddock Journal: J Neurotrauma Date: 2017-09-26 Impact factor: 5.269
Authors: Juan Antonio Llompart Pou; Josep María Abadal Centellas; Margarita Palmer Sans; Jon Pérez Bárcena; Marcial Casares Vivas; Javier Homar Ramírez; Jorge Ibáñez Juvé Journal: Intensive Care Med Date: 2004-06-09 Impact factor: 17.440
Authors: Walter Mauritz; Heinz Steltzer; Peter Bauer; Lorenz Dolanski-Aghamanoukjan; Philipp Metnitz Journal: Intensive Care Med Date: 2008-03-26 Impact factor: 17.440