PREDICTIVE FACTORS FOR EARLY MORTALITY IN SEVERE BRAIN-INJURED PATIENTS

OBJECTIVES: To define hazard factors of early mortality in severe brai n injured patients. PATIENTS AND METHODS: An open prospective study wa s conducted in 125 brain injured patients with initial Glasgow coma sc ore below 8. Different vital parameters were recorded daily during the first 10 days of resuscitation. Computed tomography (CT) san classifi cation of the Traumatic Coma Data Bank, the Glasgow coma score, the SA PS score and the influence of neurosurgery were assessed. RESULTS: in exclusive parameters analysis, a Glasgow coma score below 6, the prese nce of a midline shift of more than 5 mm on the initial brain CT scan, high or mixed density, lesion of more than 25 cc, as well as mean blo od pressure below 90 mm Hg were respectivly correlated with early deat h. Low mean blood pressure led to low brain perfusion pressure in pati ents with intracranial hypertension. CONCLUSION: We defined 3 independ ent predictive factors of early mortality: the Glasgow coma scale, CT scan classification and mean blood pressure below 90 mm Hg. The main g oal of the resuscitation in severe brain insult patients must be to ob tain a sufficient brain perfusion pressure. This often requires the us e of vasoactive drugs.