Document Detail


Neurologic outcome of posttraumatic refractory intracranial hypertension treated with external lumbar drainage.
MedLine Citation:
PMID:  17297313     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Refractory intracranial hypertension (ICH) to second level measures after severe traumatic brain injury (TBI) is associated with mortality up to 84% to 100%. The use of external lumbar drainage (ELD) has been described in these patients. We report our experience with the use of ELD in 17 cases of refractory ICH after severe TBI. METHODS: In our Level 3 Intensive Care Unit (ICU) at a university hospital, ICH is treated according to a progressive approach following the Brain Trauma Foundation guidelines. When second level measures fail to control ICH, we use an ELD as a rescue therapy if basal cisterns are discernible. Outcome at ICU discharge and 6 months after injury were analyzed using Glasgow Outcome Scale (GOS). RESULTS: Mean age was 32.5 +/- 13.3 years. ICH was reduced in all patients. ICP before ELD was 30.9 +/- 7.9 mm Hg and after ELD 14.1 +/- 5.9 mm Hg. Four patients (24%) had an ICH rebound after 5 days of ELD placement and died in the ICU. At 6 months after TBI, 13 patients (76%) presented a good outcome (GOS score of 4 and 5). No patient presented pupillary changes or cerebrospinal fluid infection during ELD use. CONCLUSION: External lumbar drainage is an effective and safe procedure to treat refractory ICH when basal cisterns are discernible. Control of refractory ICH with ELD is associated with an important reduction of mortality and a good functional recovery at 6 months.
Authors:
Josep M Abadal-Centellas; Juan A Llompart-Pou; Javier Homar-Ramírez; Jon Pérez-Bárcena; Ainhoa Rosselló-Ferrer; Jordi Ibáñez-Juvé
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  62     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-13     Completed Date:  2007-03-15     Revised Date:  2008-01-24    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  282-6; discussion 286     Citation Subset:  AIM; IM    
Affiliation:
Servicio de Medicina Intensiva, Hospital Universitario Son Dureta, Palma de Mallorca, Spain.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Brain Injuries / complications*
Cerebrospinal Fluid
Drainage / methods*
Female
Glasgow Outcome Scale
Humans
Injury Severity Score
Intensive Care Units
Intracranial Hypertension / etiology,  therapy*
Intracranial Pressure
Lumbosacral Region
Male
Middle Aged
Tomography, X-Ray Computed
Treatment Outcome
Comments/Corrections
Comment In:
J Trauma. 2007 Sep;63(3):720-1; author reply 721   [PMID:  18073625 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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