Management of comatose head-injured patients: are we getting any better?

This re-survey of neurosurgical centres was conducted to determine whether the publication of management guidelines has resulted in changes in the int ensive care management of severely head-injured patients (defined as Glasgo w Coma Score <9) in the UK and Ireland. Results were compared with data col lected from a similar survey conducted 2 years earlier. Almost 75% of centr es monitor intracranial pressure in the majority of patients and 80% now se t a target cerebral perfusion pressure of >70 mmHg. The use of prolonged hy perventilation (> 12 h) is declining and the target PaCO2 is now most commo nly >4 kPa. More centres maintain core temperature <36.5<degrees>C. Althoug h wide variations in the management of severely head-injured patients still exist, we found evidence of practice changing to comply with published gui delines.