Treating the Brain Still Hard to Do

Pressure monitoring not better than other methods in treating traumatic brain injuries

(RxWiki News) Caring for the brain is a big deal. Traumatic brain injuries are hard to treat with medicine and they take an emotional toll on the families involved.

A new study has found that intracranial pressure monitoring works about the same as other methods in treating serious injuries to the brain.

The results show that treatment should thus be more focused and use multiple methods, according to researchers.

"Protect your noggin — wear a helmet."

Randall Chesnut, a UW Medicine neurosurgeon at Harborview Medical Center in Seattle, led the study on 324 patients treated at six intensive care units in Bolivia and Ecuador for serious brain injuries, mostly caused by traffic incidents. Participants were at least 13 years of age and were randomly assigned to one of two groups between September 2008 and October 2011.

Intracranial pressure monitoring is the standard treatment for patients who endure severe blows to the head, which is the leading cause of death among young adults. With raised pressure inside the skull, the nervous system and blood vessel tissues within are compressed more than normal, which could cause serious brain damage or death.

A little more than 40 percent had swelling of the brain with about one-third needing surgery. Various fluid filled areas around the brain that serve as protective buffers were compressed or absent in 85 percent of the patients.

The first group received intracranial pressure monitoring to maintain readings less than 20 mm of mercury, which goes with the guidelines to treat severe traumatic brain injury. The other group had a clinical examination and radiographic images taken of their head.

For both groups, researchers measured the length of time patients lived, how long they were consciously impaired and, through a series of tests, how well they were able to function three and six months after the injury.

The tests covered patients' memory, ability to learn and process information, speaking abilities and motor function. The examiners didn't know who was receiving which method of treatment.

Researchers found little difference between the two methods. The pressure-monitoring group scored 56 on the series of tests while the imaging group scored 53. Patients stayed in the intensive care unit 12 days and nine days respectively.

However, the imaging group spent about five days receiving specific brain treatments, such as getting extra fluid for the brain and using hyperventilation, compared to a little more than three days among the other group.

Knowing that watching for changes in intracranial pressure doesn't affect patients changes things, according to Dr. Chestnut.

"Within this field, this is a game changer," he said in a press release. "We've been treating a number not a physiology."

Among the pressure monitoring group, 39 percent died six months after the injury, compared to 41 percent in the other group. With multiple ways to watch and treat these injuries, patients should have less unnecessary and more focused treatment, he said.

The authors note the findings don't necessarily reflect what would happen in other populations. The study, funded by the National Institutes of Health, the Fogarty International Center, the National Institute of Neurological Disorders and Stroke, and Integra Life Sciences, was published December 12 in the New England Journal of Medicine.

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Review Date: 
December 17, 2012