RESUMEN
The increased intra cranial pressure is the most significant factor determining morbidity and mortality in patients with severe closed head injury. The continuous monitoring of the ICP is very useful in assessing the ICP dynamics. The purpose of this study was to assess the effect of continuous ICP monitoring in determining the outcome of severe head injury. And how far ICP monitoring can limit the indiscriminate use of therapies to control ICP which themselves can he potentially harmful. Forty patients with severe head injury, with Glasgow Coma Scale [GCS] 8 or less, were involved in this study. On arrival to casualty unit, resuscitation started, general examination was done to assess cardiopulmonary system, and to detect any other associated injuries. All patients were intuhated, sedated, and ventelated. Intubation was facilitated with succinyl choline. Intracranial pressure [ICP] monitoring is done via ventricular catheter using hemodynamic monitor. Monitoring was continued for 48 hrs in controlled cases, and it was contintied when ICP was not controlled. Control of intracranial pressure was done by: I] -Brain dehydrating measures. II]-Dexamethason. III]-Cerebrospinal fluid drainage, and If ICP was still persistently elevated, trials were made to elevate mean arterial pressure [MAP] by using volume expansion and inotropics. These measures used to maintain cerebral perfusion pressure [CPP]. CT scan was done for all patients. Mean arterial pressure [MAP] and cerebral perfusion pressure [CPP] were measured and the injury admission time was recorded for all patients. The outcome was assessed according to Glasgow Outcome Scale. The outcome was divided into two groups: favorable outcome group and unfavorable outcome group. As regard to ICP, it's found that: 35% of cases had ICP<20 mm Hg. 64% of this group had favorable outcome while 36% had unfavorable outcome, Glasgow Coma Scale was >5 in 71% of cases and CT scan finding was normal and defuse lesion [N and D] in 64%. The intracranial pressure was >/= 20 mmHg in 65% of cases. 23% of this group had favorable outcome while 77% had unfavorable outcome GCS was > 5 in 38% of cases and CT scan findings were normal and defuse brain lesions [N and D] in 35% of cases. ICP was significantly higher in the unfavorable group [P<0.01] and injury admission time was significantly longer in the unfavorable group [<0.05], while the mean arterial pressure and cerebral perfusion pressure were significantly lower in the unfavorable group [P<0.05 and P<0.07 respectively]. Osmotherapy reduced the intracranial pressure 22.3 +/- 27%and the duration of reduction was 4.79 +/- 2.1 hours while the CSF drainage reduced the ICP 50.2 +/- 9.6% and the duration of reduction was 5.3 +/- 6.3 hours .The incidence of complication was slipped catheter in two cases. No cases of infection from the catheter were recorded. Mean duration of monitoring was 5 days [maximum 14 days]. The mortality rate was 35%[15 patients]. Intracranial pressure monitoring:[l] helps in early detection of intracranial pressure changes, [2] It can limit the indiscriminate use of therapies to control ICP which themselves can be potentially harmful[3] It can reduce ICP by CSF drainage directly and thus improve cerebral perfusion, [4] It helps in determining prognosis, and [5] It helps to improve the outcome. In prolonged monitoring [>4 days], daily bacteriological examination of CSF for early detection of contamination is recommended