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BTF Guidelines 4th Edition

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Article
Neurosurgical therapy aims to minimize secondary brain damage after a severe head injury. This includes the evacuation of intracranial space-occupying hematomas, the reduction of intracranial volumes, external ventricular drainage, and aggressive therapy in order to influence increased intracranial pressure (ICP) and decreased P(ti)O2. When conservative treatment fails, a decompressive craniectomy might be successful in lowering ICP. From September 1997 until December 2004, we operated on 836 patients with severe head injuries, of whom 117 patients (14%) were treated by means of a decompressive craniectomy. The prognosis after decompression depends on the clinical signs and symptoms at admission, patient age, and the existence of major extracranial injuries. Our guidelines for decompressive craniectomy after failure of conservative interventions and evacuation of space-occupying hematomas include: patient age below 50 years without multiple trauma, patient age below 30 years in the presence of major extracranial injuries, severe brain swelling on CT scan, exclusion of a primary brainstem lesion or injury, and intervention before irreversible brainstem damage.
Chapter
The issue of determining the most beneficial CPP was a topic of considerable discussion during the last ICP meeting. From that discussion, it was apparent that the data gathered over the last 9 years at the University of Louisville Trauma Center could best answer that question.
Chapter
The chronic administration of osmotic agents might be an effective way to treat elevated intracranial pressure (ICP) if the systemic effects of water and electrolyte depletion could be avoided. ICP reduction is not dependent upon diuresis or water and electrolyte depletion. It is primarily a function of the osmotic gradient between brain and plasma created by the osmotic agent. We therefore felt that replacement of the output from diuresis would not affect ICP reduction and might permit us to use osmotic agents over a prolonged period of time.
Chapter
Continuous monitoring of intracranial pressure (ICP) has become a crucial component in the management of the comatose head injured victim. Early increased ICP is produced by a variety of pathological conditions, such as hematoma formation, hypoventilation, and cerebral swelling. The relationship of systemic hypotension and increased ICP has yet to be clearly understood. In this prospective study we have attempted to clarify some of these relationships.
Chapter
The results of a double-blind study on the effects of a low dose and a high dose of dexamethasone on severe closed head injury are presented. The steroid, particularly in high dose, reduced mortality, improved the neurologic course and the final outcome. Timing of steroid administration is of great importance.