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Intensive care and traumatic brain injury after the introduction of a treatment protocol: a prospective study
Author(s) -
SCHIRMERMIKALSEN K.,
MOEN K. G.,
SKANDSEN T.,
VIK A.,
KLEPSTAD P.
Publication year - 2013
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.1399-6576.2012.02785.x
Subject(s) - medicine , traumatic brain injury , hyponatremia , pneumonia , intensive care unit , glasgow coma scale , anesthesia , blood pressure , hypoalbuminemia , head injury , intensive care , intracranial pressure , surgery , intensive care medicine , psychiatry
Background Traumatic brain injury ( TBI ) treatment protocols have been introduced in the intensive care unit ( ICU ) to avoid secondary brain injury. In this study, we aimed to evaluate the deviations from such a treatment protocol and the frequency of extracranial complications, and relate these findings to outcome. Methods During a 5‐year period (2004–2009), 133 patients with severe TBI [ G lasgow C oma S cale ( GCS ) score ≤ 8] were prospectively included. The following deviations from treatment goals were studied: intracranial pressure ( ICP ), blood pressure, haemoglobin, blood glucose, serum sodium, serum albumin, body temperature and extracranial complications during the ICU stay. Outcome was assessed using G lasgow O utcome S cale E xtended score at 12 months. Results The frequencies of deviations from the treatment goals were: episodes of intracranial hypertension 69.5% (of monitored patients), hypotension 20.3%, anaemia 77.4%, hyperglycaemia 42.9%, hyponatremia 34.6%, hypoalbuminemia 30.8% and hyperthermia 54.9%. Pulmonary complications were common (pneumonia 72.2%, acute respiratory distress syndrome/acute lung injury 31.6%). Thrombocytopenia (4.5%), severe sepsis (3.0%), renal failure (0.8%) and liver failure (0.8%) were infrequent. Twenty‐six (19.5%) patients died within the first 12 months due to the head injury. Age, GCS score, pupil dilation, I njury S everity S core ( ISS ), ICP > 25 mmHg, hyperglycaemia and pneumonia predicted a worse outcome. Conclusions Deviations from the TBI treatment protocol were frequent. Pneumonia was the most frequent extracranial complication. Age, GCS score, pupil dilation, ISS , high ICP , hyperglycaemia and pneumonia predicted a worse outcome.