Traumatic brain injury: analysis of 64 cases managed in a general intensive care unit

Background

The modern management of traumatic brain injury (TBI) resulted in a significant reduction in mortality and functional deficit. These advances are imputed to the introduction of neurosurgical intensive care units (ICUs) and the implementation of guidelines to prevent secondary insult. However, in Brazil, most patients with TBI are managed in general ICUs. The results of the treatment of patients admitted to nonspecialized ICUs must be compared with those obtained in neurosurgical ICUs.

Objective

We evaluated retrospectively a group of patients with TBI managed at a general ICU. Epidemiological aspects, severity evaluation, monitoring and the impact of therapeutic interventions were analyzed. The extended Glasgow Outcome Scale [1] was used to evaluate the long-term prognosis of patients discharged from the unit.

Patients

All adult patients with TBI admitted to a general ICU from February 2000 to December 2002 were included. Patients who were discharged and those that died in the first 24 hours after admission to the ICU were excluded.

Measurements and results

Thirty patients (46.9%) had a Glasgow Coma Scale of 3–8 on admission. The 10 patients that died in the ICU belonged to this group. Thirty-three patients were victims of motor vehicle accidents and 26 (40.6%) had major extracranial injuries. In 50 patients, tomographic results could be classified according to the Traumatic Coma Data Bank. Diffuse injury I (14 cases), diffuse injury II (14 cases) and nonevacuated mass lesion (10 cases) were the most frequent findings. It was not possible to identify any impact of admission glycemia > 110 mg/dl, PaO₂/FiO₂ and mean PaCO₂ in the first 72 hours on mortality. The intracranial pressure was monitored in six patients and the jugular bulb oxygen saturation in seven patients. The Glasgow Outcome Scale was evaluated in 40 (62%) patients. Assessment was carried out ≥ 6 months after the date of injury (median 29 months). Thirteen patients died, 10 while at the ICU. Sixteen patients made a good recovery; eight (20%) had moderate disability and three (7.5%) had severe disability. No patient remained in a vegetative state.

Conclusions

Our results, compared with studies that analyzed patients managed at neurosurgical ICUs [2], demonstrated that patients with TBI admitted to a general ICU with resources to prevent and treat secondary injury have mortality and functional results after discharge comparable with patients managed at specialized ICUs.