Brain injury, traumatic intracranial hypertension

A significant reduction of the ICP was seen, which was similar to the results of Marion and Shiozaki, who used hypothermic therapy in traumatic brain injuries (37,38). With an unaffected mean arterial blood pressure (MABP) and increased cerebral perfusion pressure (CPP), hypothermic therapy appeared to benefit stroke patients, as uncontrolled intracranial hypertension is the main cause of death in the first week after stroke. However, rewarming the patients consistently led to a secondary rise of ICP, which required additional ICP therapy with mannitol. In some cases it even exaggerated the initial ICP levels (Fig. 3). 

Comparative studies In a randomized controlled trial of thiopental and pentobarbital in the control of refractory intracranial hypertension in 44 patients with severe traumatic brain injuries the former was more efficacious in reducing refractory intracranial pressure (OR = 5.1) [9(T]. There were no differences in adverse effects with respect to infections or the SOFA score before or maximum score attained between the two groups almost all of the patieuts had hypotension on at least one occasion. 

Perez-Barcena J, Llompart-Pou JA, Homar J, Abadal JM, Raurich JM, Frontera G, Brell M, Ibdnez J, Ibtihez J. Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury a randomized controlled trial. Crit Care 2008 12(4) R112. 

Jiang, J.-Y., Xu, W., Li, W.-R, et al., 2005. Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury a multicenter, prospective, randomized controlled study. J. Neurotrauma 22, 623-628. 

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