Volume 13 Supplement 3
Implementation of the protocol of decompressive craniectomy: does it really improve outcome?
© BioMed Central Ltd 2009
Published: 23 June 2009
Treatment of traumatic brain injury (TBI) and other conditions that increase intracranial pressure (ICP) continues to be a challenge for intensivists and neurosurgeons. Despite adequate monitoring, the mortality and morbidity rate remain high. Decompressive craniectomy (DC) can be performed where maximum medical therapy has failed to reduce ICP.
To analyze the viability of the DC protocol, since implementation, in the former 23 months. To identify the applicability of the protocol as an instrument for DC indication.
A prospective, descriptive, series study, realized by the UPG-UCI of the Emergency and Neurosurgery Service. Criteria for ICU admission: age >18 years and <60 years, <48 hours at admission (except patients with tumor), Glasgow Coma Scale (GCS) >4, decline for 3 points with the first GCS, extensive unilateral brain trauma, intraoperative evidence of brain swelling; image evidence of intracranial hypertension (ICH), stroke or brain trauma with mass effect and midline shift. Maximum medical therapy to reduce ICP, when possible: drainage of cerebrospinal fluid; induced hyperventilation; intravenous hyperosmotic solutions; head elevation; sedation and neuromuscular paralysis; barbiturate coma; and hypothermia. The protocol includes clinical, neurological and image signs. The patients' evolution was appraised by 3-month mortality, GCS and modified Rankin Scale.
Implementation of the protocol, based on recent studies, allows one to establish, with more accuracy, the best indication for DC, improving outcome. Despite small casualties, DC was effective to treat otherwise uncontrollable ICH and improved cerebral perfusion pressure. All patients presented a satisfactory clinical evolution and outcome after the procedure. The neurointensive care unit allowed an adequate treatment indication and management of these complex patients.
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