Premium
Neurointensive care of patients with severe community‐acquired meningitis
Author(s) -
EDBERG M.,
FUREBRING M.,
SJÖLIN J.,
ENBLAD P.
Publication year - 2011
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2011.02460.x
Subject(s) - medicine , neurointensive care , glasgow outcome scale , meningitis , intracranial pressure , decompressive craniectomy , streptococcus pneumoniae , intracranial pressure monitoring , anesthesia , external ventricular drain , traumatic brain injury , glasgow coma scale , surgery , cerebrospinal fluid , psychiatry , biology , bacteria , genetics
Background: Reports about neurointensive care of severe community‐acquired meningitis are few. The aims of this retrospective study were to review the acute clinical course, management and outcome in a series of bacterial meningitis patients receiving neurointensive care. Methods: Thirty patients (median age 51, range 1–81) admitted from a population of 2 million people during 7 years were studied. The neurointensive care protocol included escalated stepwise treatment with mild hyperventilation, cerebrospinal fluid (CSF) drainage, continuous thiopentotal infusion and decompressive craniectomy. Clinical outcome was assessed using the Glasgow outcome scale. Results: Twenty‐eight patients did not respond to commands on arrival, five were non‐reacting and five had dilated pupils. Twenty‐two patients had positive CSF cultures: Streptococcus pneumoniae ( n =18), Neisseria meningitidis ( n =2), β‐streptococcus group A ( n =1) and Staphylococcus aureus ( n =1). Thirty‐five patients were mechanically ventilated. Intracranial pressure (ICP) was monitored in 28 patients (intraventricular catheter=26, intracerebral transducers=2). CSF was drained in 15 patients. Three patients received thiopentothal. Increased ICP (>20 mmHg) was observed in 7/26 patients with available ICP data. Six patients died during neurointensive care: total brain infarction ( n =4), cardiac arrest ( n =1) and treatment withdrawal ( n =1). Seven patients died after discharge, three due to meningitis complications. At follow‐up, 14 patients showed good recovery, six moderate disability, two severe disability and 13 were dead. Conclusion: Patients judged to have severe meningitis should be admitted to neurointensive care units without delay for ICP monitoring and management according to modern neurointensive care principles.