Skip to content

Advertisement

  • Meeting abstract
  • Open Access

Survey of severe head injury treatment in Brazil

  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care20037 (Suppl 3) :P80

https://doi.org/10.1186/cc2276

  • Published:

Keywords

  • Intensive Care Unit
  • Corticosteroid
  • Traumatic Brain Injury
  • Brain Injury
  • Head Injury

Introduction

Head injury has been one of the most important public health problems, with high morbidity and mortality rates. In Brazil, the DATASUS (official government databank) reported 63,919 deaths caused by head injury during the year 2001. Increasing knowledge on traumatic brain injury physiopathology made possible the establishment of better guidelines for its treatment. However, there are no consistent data regarding the implementation of these guidelines in the management of head injury in Brazil.

Objectives

To evaluate the treatment protocols of severe head injury in Brazilian intensive care units (ICUs).

Methods

Between August 2002 and January 2003 a questionnaire was sent to 628 ICUs in Brazil. The data obtained were tabulated as categorical variables.

Results

A total of 107 ICUs (17.3%) answered the questionnaire. From that total, 14 ICUs were excluded because they do not treat head injury patients on a regular basis. The results are presented in Tables 1,2,3,4, as the number and percentage of ICUs.

Table 1

Use of corticosteroids

n

%

Always

5

5

Never

47

51

Traumatic subarachnoid hemorrhage

27

29

HIV

17

18

Depressed skull fractures

3

3

Diffuse axonal lesion

8

9

Brain swelling

8

9

Intracranial pressure > 20 mmHg

2

2

Other reasons

6

6

Intracranial hypertension control

13

14

Use of corticosteroids (total)

46

49

Table 2

Intracranial pressure monitoring indications

n

%

GCS < 9 with abnormal computed tomography

60

86

GCS < 9 with normal computed tomography+ risk factors

36

51

Intracranial hematomas

14

20

Intraventricular hemorrhage

17

24

All listed indications

5

7

It was not informed

3

4

Other indications

7

10

GCS, Glasgow Coma Scale.

Table 3

Intracranial hypertension management

n

%

Hyperventilation PaCO2 ≤ 25 mmHg

45

48

Mannitol

86

92

Thiopental

59

63

Furosemide

20

22

Volume restriction

17

18

Corticosteroids

13

14

Liquor drainage

56

60

Hyperventilation without intracranial pressure

13

14

Liquor drainage without PIC

7

8

Table 4

Management of severe head injury

n

%

ICP monitoring

62

67

Capnography

46

49

Jugular bulb oximetry (SjO2)

32

34

Initial hyperventilation in all cases

38

41

Hyperventilation without SjO2

31

33

Hyperventilation without capnography

22

24

Hyperventilation without ICP monitoring

12

13

Hyperventilation without capnography/SjO2

11

12

Hyperventilation without capnography/ICP/SjO2

9

10

SjO2 without ICP

4

4

It was not informed

8

9

ICP, intracranial pressure.

Conclusion

A considerable number of Brazilian ICUs are still using treatment strategies that are no longer recommended by the actual medical literature (corticosteroids, routine hyperventilation, etc.). This fact claims for new campaigns and continued education for dissemination and implementation of the current guidelines on severe head injury management.

Authors’ Affiliations

(1)
Hospital Israelita Albert Einstein, Av Albert Einstein, São Paulo, SP, Brazil

Copyright

Advertisement