Articles: brain-injuries.
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Swiss medical weekly · Aug 1982
[Experience with measurements of intracranial pressure in post-hypoxic and post-traumatic coma].
In 27 patients intracranial pressure monitoring (ICP) was carried out for 4-5 days (severe head injury 23, hypoxia after cardiac arrest 3, brain tumor 1). Patients were included who reached a score of 8 or less on the Glasgow Coma Scale and who did not need immediate surgery. The measurements were done with epidural screws (20 patients) and with indwelling ventricular catheters 7). ⋯ Poor Glasgow scores were linked to high mortality. The advantages and disadvantages of the two ICP monitoring techniques are discussed. ICP monitoring is recommended as a useful and safe tool for titrated management of deeply comatose patients.
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Journal of neurosurgery · Apr 1982
Randomized Controlled Trial Comparative Study Clinical TrialEffect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury.
During 1977-1978, 127 patients with severe head injury were admitted and underwent intracranial pressure (ICP) monitoring. All patients had Glasgow Coma Scale (GCS) scores of 7 or less. All received identical initial treatment according to a standardized protocol. ⋯ Twenty-six patients (25%) had ICP's of 25 mm Hg or greater, compared to 34% in the previous series (p less than 0.05), and 18 of these 26 patients (69%) died. The overall mortality for this current series was 28% compared to 46% in the previous series (p less than 0.0005). This study reconfirms the high mortality rate if ICP is 25 mm Hg or greater; however, the data also document that early aggressive treatment based on ICP monitoring significantly lessens the incidence of ICP of 25 mm Hg or greater and reduces the overall mortality rate of severe head injury.
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Intensive care of the patient who has acute brain injury has undergone major changes. Neurologic monitoring, particularly continuous recording of the intracranial pressure, appears to have contributed to an improved outcome in head-injured patients. ⋯ Other techniques such as cerebral blood flow measurements, reflectance spectrophotometry, and sophisticated electrophysiologic recording are being utilized in the laboratory and in man as monitoring techniques. There utility and potential applications are discussed, and the present role of monitoring reviewed.