A standardized neurosurgical/neurointensive therapy directed toward vasogenic edema after severe traumatic brain injury: clinical results

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Abstract
Objective: Analysis of a standardized therapy focusing on prevention and treatment of vasogenic edema in patients suffering severe traumatic brain injury (TBI). Design: A retrospective analysis. Setting: Neurointensive care unit at Sahlgrenska University Hospital, Göteborg, Sweden. Patients: 38 patients with severe TBI were included. The median Glasgow Coma Score was 5 (range 3–8) and median age 27 years (range 5–70 years). Interventions: Measurement of intracranial pressure (ICP). Surgical evacuation of hematomas and contusions. Volume expansion aiming at normovolemia. Sedation with continuous intravenous infusion of low-dose thiopentone and reduction of stress response by clonidine. Normalization of capillary hydrostatic pressure by metoprolol and clonidine. If ICP and cerebral perfusion pressure (CPP) were not stabilized (ICP < 20 mm Hg and CPP > 60 mm Hg), a continuous infusion of dihydroergotamine was added. In 4 patients a craniectomy was performed. Results: Of the 38 patients, 27 (71 %) survived with good recovery or moderate disability, 5 (13 %) survived with severe disability, 1 (3 %) remained in a vegetative state, and 5 (13 %) died. The mortality due to intracranial hypertension was 11 % (4 patients). Conclusion: A therapy focusing on treatment of the assumed vasogenic edema in combination with aggressive neurosurgery resulted in an outcome as good as the best previously reported.

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