Geen bewijs voor de effectiviteit van de drukgestuurde behandeling van traumatisch schedel-hersenletsel

The treatment of traumatic brain injury (TBI) in the intensive care unit is mainly based on the prevention of secondary insults and damage. The prevention of even a single episode of hypotension and/or hypoxia is of utmost importance. Apart from general measures to establish the latter, many non-surgical modalities focusing on lowering an increased intracranial pressure (ICP) have been used. These include 1) administration of mannitol, 2) drainage of cerebrospinal fluid, 3) administration of barbiturates, 4) hyperventilation, 5) induction of hypothermia and 6) administration of high-dose corticoids. Although a specific intervention can reduce an elevated ICP, it does not necessarily results in an improved outcome. A critical appraisal of the literature demonstrates that despite the presence of international guidelines for treatment based on the measurement of ICP - there is very little firm scientific evidence for standard implementation of above interventions.