Guidelines for the treatment of acidaemia with THAM.
Despite of the use of all the current intensive care measures, some patients develop dangerously high intracranial pressures (ICP) after head injury. We have studied the use of THAM for the rapid control of dangerously high ICP in these patients. PATIENT AND METHODS. After all conventional methods of lowering ICP had been applied without sufficient effect, 1 mmol/kg body wt. THAM was given i.v. over a period of 10 min to ten patients with head injury. All patients were hyperventilated, sedated with thiopental (3-6 g/day), and the upper body was elevated to 30 degrees. The intracranial pressure and mean arterial pressure were monitored, arterial blood gas levels measured, and cerebral perfusion pressure (CPP) calculated. RESULTS. Our patients had a mean ICP of 37.4 Torr, which fell to 27.2 Torr within 10 min after the administration of THAM. The CPP rose from 46.5 to 56.3 Torr, no rebound was observed. There was no change in arterial blood gas values. DISCUSSION. Our study indicates that THAM not only decreases an elevated ICP, but also improves CPP. These results are of note because only patients with otherwise unresponsive increases in ICP were included.