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An outcome study of severe traumatic head injury using the "Lund therapy" with low-dose prostacyclin
Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Anesthesiology and Intensive Care.
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2001 (English)In: Acta Anaesthesiol Scand, Vol. 45, no 4, 402-6 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There are two independent head injury outcome studies using the "Lund concept", and both showed a mortality rate of about 10%, and a favourable outcome (Glasgow outcome scale, GOS 4 and 5) of about 70%. The Lund concept aims at controlling intracranial pressure, and improving microcirculation around contusions. Intracranial pressure is controlled by maintaining a normal colloid osmotic pressure and reducing the hydrostatic capillary pressure. Microcirculation is improved by ensuring strict normovolaemia and reducing sympathetic discharge. The endogenous substance prostacyclin with its antiaggregatory/antiadhesive effects may further improve microcirculation, which finds support from a microdialysis-based clinical study and an experimental brain trauma study. The present clinical outcome study aims at evaluating whether the previously obtained good outcome with the Lund therapy can be reproduced, and whether the addition of prostacyclin has any adverse side-effects. METHODS: All 31 consecutive patients with severe head injury, Glasgow coma scale (GCS) < or = 8, admitted to the University Hospital of Umea during 1998 were included. The Lund therapy including prostacyclin infusion 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 disability. Of the 22 patients with favourable outcome, 19 showed good recovery and 3 moderate disability. No adverse side-effects of prostacyclin were observed. CONCLUSION: The outcome results from previous studies using the Lund therapy were reproduced, and no adverse side-effects of low-dose prostacyclin were observed.

Place, publisher, year, edition, pages
2001. Vol. 45, no 4, 402-6 p.
Keyword [en]
Adolescent, Adult, Aged, Antihypertensive Agents/administration & dosage/adverse, effects/*therapeutic use, Clinical Protocols, Craniocerebral Trauma/*therapy, Epoprostenol/administration & dosage/adverse effects/*therapeutic use, Female, Glasgow Coma Scale, Humans, Male, Middle Aged, Monitoring, Physiologic, Tomography, X-Ray Computed, Treatment Outcome
URN: urn:nbn:se:umu:diva-31422ISBN: 0001-5172 (Print)OAI: diva2:293007
Naredi, S Olivecrona, M Lindgren, C Ostlund, A L Grande, P O Koskinen, L O Research Support, Non-U.S. Gov't Denmark Acta anaesthesiologica Scandinavica Acta Anaesthesiol Scand. 2001 Apr;45(4):402-6.Available from: 2010-02-10 Created: 2010-02-10 Last updated: 2010-02-10

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