An outcome study of severe traumatic head injury using the "Lund therapy" with low-dose prostacyclin

Background: There are two independent head injury outcome studies using the "Lund concept", and both showed a mortality rate of about 10%, and a favou rable outcome (Glasgow outcome scale, GOS 4 and 5) of about 70%. The Lund c oncept aims at controlling intracranial pressure, and improving microcircul ation around contusions. Intracranial pressure is controlled by maintaining a normal colloid osmotic pressure and reducing the hydrostatic capillary p ressure. Microcirculation is improved by ensuring strict normovolaemia and reducing sympathetic discharge. The endogenous substance prostacyclin with its antiaggregatory/antiadhesive effects may further improve microcirculati on, which finds support from a microdialysis-based clinical study and an ex perimental brain trauma study. The present clinical outcome study aims at e valuating whether the previously obtained good outcome with the Lund therap y can be reproduced, and whether the addition of prostacyclin has any adver se side-effects. Methods: All 31 consecutive patients with severe head injury, Glasgow coma scale (GCS) less than or equal to8, admitted to the University Hospital of Umea during 1998 were included. The Lund therapy including prostacyclin inf usion for the first three days at a dose of 0.5 ng kg(-1) min(-1). Outcome was evaluated according to the GOS >10 months after the injury. Results: One patient died, another suffered vegetative state and 7 severe d isability. Of the 22 patients with favourable outcome, 19 showed good recov ery and 3 moderate disability. No adverse side-effects of prostacyclin were observed. Conclusion: The outcome results from previous studies using the Lund therap y were reproduced, and no adverse side-effects of low-dose prostacyclin wer e observed.