In spite of high-dose steroid, hyperventilation, hyperosmolar agents, appropriate surgical evacuation, and cerebrospinal fluid drainage when possible, uncontrolled intracranial hypertension, which was defined as occurring when intracranial pressure (I...
In spite of high-dose steroid, hyperventilation, hyperosmolar agents, appropriate surgical evacuation, and cerebrospinal fluid drainage when possible, uncontrolled intracranial hypertension, which was defined as occurring when intracranial pressure (ICP) exceeded 25㎜Hg for 2 hours or more. occurred in 8 patients. Persistent elevated ICP occurred in 4 patient with acute subdural hematoma and brain contusion, in 2 patients with aneurysm and brain infarction, in 1 patient with hypertensive intracerebral hematoma, and in 1 patient with meningioma. All of these patients received intravenous barbiturate to control the ICP. The initial thiopental loading dose(10㎎/㎏) effectively reduced the ICP in 5 patients (62.5%). In those patients responding to the initial loading dose, four have survived, and one died due to pulmonary comlication.
None of three nonresponders to barbiturate survived.
Two of the survivors have returned to a productive life, and two remain moderately disabled. The favorable outcome in this series suggests that early aggressive treatment of intracranial hypertension with barbiturate and careful attention to medical complications can improve the outcome in patients with uncontrolled intracranial hypertension, with barbiturate and careful attention to medical complications can improve the outcome in patients with uncontrolled intracranial hypertension, especially in postoperative state. A broader investigation of the clinical application of barbiturates is indicated.