Management of moderate and severe head injury in neurosurgical units in Australasia.

A survey of the 31 neurosurgical units in Australia and New Zealand was undertaken by the Trauma Committee of the Neurosurgical Society of Australasia to determine areas of common practice and areas of divergence in management protocols in the treatment of moderate and severe head injury. Intracranial pressure (ICP) measurement was a fundamental component of care in the majority of units with rises in ICP being treated by sedation, mild hyperventilation (p(a)CO(2) of 30-35 mm Hg) and osmotherapy or cerebrospinal fluid drainage as first choices. Where the ICP was measured selectively following a severe head injury, the computed tomography appearance was used as the criterion for initiation of measurement. All units used at least an arterial line, a central venous pressure monitor and end-tidal CO(2) measurement routinely to monitor progress. Attention to the cerebral perfusion pressure with volume support and pressors, together with less intense hyperventilation, were the most common alterations to management protocols made over the preceding 2 years.