Head InjuryThere is another approach proposed in literature for intracranial hypertension control in cases of head trauma. It is the  Lund therapy or protocol, developed at the University of Lund, Sweden. And below we provide you with table filled with various approaches to treat intracranial hypertension in severe head trauma.

The differences between those approaches, the principle objectives of the approaches, clearly compared in this following table of intracranial hypertension treatment in head trauma. The table is described as followed:

  Traditional approach Control
of CPP		 Lund
therapy		 Individual
treatment
General procedure        
Head position Elevated to 15-30ยบ Neutral position Neutral position Any position that allows better CBF and better ICP
Sedation Opiate + benzodiazepine No Small doses of thiopental Opiate + benzodiazepine
Arterial hypertension treatment Yes, labetalol No Metoprolol + clonidine Ischemia/
hypoperfusion pattern: no treatment Appropriate perfusion treatment: labetalol
Nutritional support Yes, avoid hyperglycemia No Yes, avoid hyperglycemia Yes, avoid hyperglycemia
Treatment of intracranial hypertension        
Neuromuscular blockade Yes Yes No Yes
Hyperventilation Yes No No

Ischemia/hypoperfusion
pattern: No
Appropriate perfusion: Yes
Fluid drainage Yes Yes No Yes
Osmotic therapy Yes Yes No Hypoperfusion/edema pattern: Yes Hyperemia/vascular dilation: No
Barbiturate-induced coma Yes No No Hypoperfusion/edema pattern: No Hyperemia/vascular dilation: Yes
Control of cerebral perfusion pressure (CPP)        
Objectives for CPP Not considered keep ICP < 20 mmHg and normal AP > 70-80 mmHg (above lower limit of autoregulation) > 50-60 (allowing appropriate perfusion) Ischemia/hypoperfusion pattern: increase CPP in order to improve CBF, especially if autoregulation is affected Appropriate perfusion pattern: keep normal CPP

source: scielo.br