Stepwise management of severe traumatic brain injured patients guided by ICP monitoring

Objective To elucidate the effectiveness of stepwise management of elevated intracranial pressure guided by ICP monitoring for severe traumatic brain injured(TBI) patients. Methods 128 patients with severe TBI, GCS score 3～5 in 55 cases and GCS score 6～8 in 73 cases, admitted at Shanghai Neurosurgical Emergency Center from Nov. 2004 to Jan. 2006 were evaluated prospectively. A ventriculostomy catheter was implanted routinely and intracranial pressure was measured continuously for 4～9 days. A staircase intracranial pressure control algorithm for controlling intracranial pressure and maintaining cerebral perfusion pressure was adopted. Results According to GOS for assessment of outcome, 72 cases (56.3% ) survived with good recovery, 12 cases (9.4% ) with moderate disability, 23 cases (18.0%) with severe disability, 10 cases (7.8%) with vegetative status and 11 cases (8.6%) died. Conclusions Intraventricular ICP monitoring has played an important role in the management of severe traumatic brain injured patients. Stepwise management of elevated intracranial pressure can effectively assist in controlling intracranial pressure, maintaining cerebral perfusion pressure and decreasing the disability rate and mortality.