Assessment of changes in Intracranial Pressure (ICP) after the implementation of therapeutic measures for Intracranial Hypertation (IH)

The Traumatic Brain Injury (TBI) constitutes the leading cause of death and permanent disability in all age groups and, by far, at ages 19-27 years. The morbidity and mortality remain high and depend on the neurological status of patients at admission, the treatment in the Intensive Care Unit (ICU), surgery and postoperative rehabilitation and recovery. The prevention and treatment factors that may maintain or exacerbate the IH is a very important and fundamental issue in neurological intensive therapy. Aim: The aim of the present systematic review was to investigate the effectiveness of various therapeutic measures for the treatment of intracranial hypertension. Material and Method: The methodology used was to review the Greek and international bibliographic databases (Iatrotek, Pubmed, Cinahl, Scopus,). The keywords used to search for the study was: "Hyperventilation", "therapeutic hypothermia", "hyperosmolar therapy", "corticosteroids", "traumatic brain injury" and were the last 15 years. Results: Hyperventilation, the hyperosmolar therapy, barbiturates, patient position, sedatives-neuromuscular blocking agents, therapeutic hypothermia, corticosteroids and some aggressive surgical methods (decompressive craniotomy and drainage of CSF) make up the puzzle of modern intensive care patients with severe TBI. The cornerstone for the control of intracranial hypertension are the hyperosmolar therapy, therapeutic hypothermia and patient position (supine-neutral to 30o-45o inclination). With skepticism, seems to treat hyperventilation, sedatives-neuromuscular blocking agents, the barbiturate coma and surgical methods of treatment. This is due to the plurality of complications that causing. Last but not least, corticosteroids have been implicated as a measure which does nothing to help patients with increased ICP, contrary aggravates their condition. Conclusions: Direct surgical treatment of IH accompanied by better results in terms of mortality, morbidity and neurologic outcome. For patients with inoperable brain lesions treated with prophylactic and therapeutic measures against IH and cerebral ischemia, the main of which are: sedation and / or muscle relaxation , pain control , temperature control, placement of head and body in the position of 30-400, the treatment of mannitol or other hypertonic solutions. Finally hyperventilation is useful tool immediate, but temporary, intervention by the deterioration of the neurological profile and until such time as an objective fact.

Keywords: Hyperventilation, therapeutic hypothermia, hyperosmolar treatment, corticosteroids, traumatic brain injury