Ealrly Metabolic Suppression Therapy for Severely Increased Intracranial Pressure after Emergency Brain Decompression

Abstract

Objective: Patients suffering from severe traumatic brain injury or cerebral hemorrhage need to be closely monitored and be intensively managed in order to prevent irreversible neurological damage. However, progressive neurological deterioration may occur despite the rapid physiologic resuscitation after emergency brain decompression. In this study, the clinical outcome of the early metabolic suppression treatment was evaluated in patients suffering from severe cases of refractory increased intracranial pressure following emergency brain decompression. Methods: We retrospectively reviewed the charts of all patients who received early metabolic suppression therapy after emergency brain decompression between January 1, 2002 and January 1, 2007. Result: A total of 42 patients were included in this study. Twelve (29%) of these have survived. Six (50%) of the survivors showed favorable outcomes (i.e., good recovery and moderate disability) at 1 year after hospital discharge. Cerebral perfusion pressure was higher in the survivors than in the non-survivors. Conclusion: Early aggressive metabolic suppression therapy with barbiturates may be used to effectively control the intracranial pressure in a substantial number of patients with severely increased intracranial pressure even after emergency brain decompression, without adversely affecting the cerebral perfusion pressure in these patients.