Effect of intracranial pressure and cerebral perfusion pressure on outcome prediction of severe traumatic brain injury

To investigate the influence of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) on neurological deterioration and outcome of severe traumatic brain injury (STBI). Methods: A total of 245 patients with severe traumatic brain injury were studied retrospectively with univariate and multivariate studies to evaluate the contribution of ICP/CPP to neurological deterioration and outcome. Results: The mortality rates rose from 16.2 % in 142 patients whose course of disease was smooth to 66.7 % in 103 patients who suffered from neurological deterioration. Correspondingly, the favorable outcome fall from 54.2 % in the patients without neurological deterioration to 18.3 % in those with neurological deterioration. In the patients with clinical evidence of neurological deterioration, the relative influence of the ICP and the CPP on outcome was assessed. The most powerful predictors of neurological deterioration was the presence of intracranial hypertension (ICP>30 mm*!Hg , 1 mm*!Hg= 0.133 kPa). The CPP also had a prognostic power on neurological deterioration when its level less than 60 mm*!Hg. Conclusions: It suggests that its very important to lower the intracranial hypertension and keep the CPP not less than 60 mm*!Hg during the treatment of STBI.