Therapy of intracranial hypertension - Innovations and perspectives

The neurological outcome in head-injured patients has improved significantl y over the last 30 years based on developments in primary care, general ICU care and new diagnostic technologies. Basic and clinical research provided the development of novel neuroprotective agents. However, all neuroprotect ive agents studied thus far have failed to improve outcome in humans. Substantial progress was made, when ICP measurement was accepted for monito ring in severely head injured patients. Subsequently, raised intracranial p ressure was recognized as a major problem for the treating physician. Over the last decades, several treatment modalities have been employed, most of them lacking rigorous evidence. It seems important to note that more than 2 0 years of basic and clinical research could not lead to a therapy which he lps the physician to treat intracranial hypertension successfully. The deve lopment of new means of extended intracerebral monitoring (ptiO(2), CBF, mi crodialysis) led to a better pathophysiological understanding of basic proc esses occurring after traumatic brain injury. Therapy begins to change its main target. Blood flow guided treatment is a possible therapeutic strategy of the future. However, practical guidelines have to reach widespread gene ral acceptance so that new therapy strategies can be tested in clinical tri als.