ABSTRACT
Raised intracranial pressure is a well-known event following a severe head injury. This rise in turn affects the cerebral perfusion pressure [CPP] and the cerebral blood flow. Fall of CPP below the critical level induces the development of secondary cerebral insults in the form of cerebral ischaemia. Authors present a study, carried out over a period of 4 years, at the National Trauma Centre, in the Sultanate of Oma, involving a total of 89 patients with severe head injury [Glasgow coma scale [GCS] of 8 or less]. These patients were aggressively managed in the Neurosurgical Intensive Care Unit with volume expanders, cerebro-spinal fluid drainage, and systemic vasopressors, in an attempt to maintain a cerebral perfusion pressure above 70 mmHg. Of the 89 patients in the study, 56 had a favorable outcome [62.9%] and 33 patients had a poor outcome [37%]. Among the patients with a poor outcome 2 [2.2%] were persistent vegetative, 9 patients [10.1%] had severe disabilities, and a mortality of 24.7% [22 cases] was recorded. Among the patients with a favourable outcome, the mean initial ICP was 13.7 mmHg and the mean initial CPP was 72.1 mmHg. The mean ICP during their monitoring phase was 11.8 mmHg, while the mean CPP was 77.9 mmHg. In contrast, those patients with a poor outcome had an initial ICP of 26.1 mmHg and initial CPP of 55.2 mmHg. Also, these patients had a mean ICP of 26.5 mmHg and a mean CPP of 55.9 mmHg, inspite of aggressive management. Measures to maintain cerebral perfusion above 70 mmHg influence the outcome in severely head injured patients in our study. We believe that adequate level of CPP is an important parameter for achieving good outcome