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The management of head injury and intracranial pressure

2002; Churchill Livingstone; Volume: 13; Issue: 3 Linguagem: Inglês

10.1054/cacc.2002.0401

1532-2033

Jing W Goh, Aditya Gupta,

Neurosurgical Procedures and Complications

Severe head injury occurs predominantly in the young population. Although the incidence is decreasing in the United Kingdom, the eventual outcome of these patients has major social and economic implications. Damage to brain tissue during head injury is both primary, due to the initial insult, or secondary, which occurs later. Because little can be done about the primary injury, the intensive care management is targeted at reducing the secondary insults which may cause further brain damage. The prevention of secondary injury involves prompt airway management and treatment of hypoxia and hypotension. Severe head injury often causes raised intracranial pressure (ICP). The management is focused on maintaining cerebral perfusion pressure, which should be maintained above 70 mmHg by adequate fluid replacement or by the judicious use of inotropes. The methods to control ICP include general measures (15° head up position, avoidance of jugular venous obstruction, prevention of hyperthermia and hypercarbia) and neurospecific measures. The neurospecific measures are particularly useful in patients with refractory intracranial hypertension. The patient may need sedation, paralysis, use of barbiturate coma, osmotherapy, moderate cooling, controlled hyperventilation or surgical intervention. This review focuses on the rationale for the use of these interventions, outlining their benefits and their pitfalls.