Prognosis for Patients with Severe Brain Injuries

Abstract

Intraventricular pressure recording has been a standard procedure in the neurosurgical clinic, University Central Hospital, Helsinki, Finland, since 1964. Up to 31 December 1970, 250 recordings had been performed, 90 of these on brain-injured patients. Intraventricular pressure correlates well with survival or death of the patient but will not predict the quality of survival. However, other criteria seem to correlate well with the quality of survival. The results of a prospective study of 50 patients between 1 January 1967 and 31 December 1969 are reported. Clues to vegetative survival are very low arterial Pco₂ after a free airway has been established, a high respiratory minute volume, temperature above 39°C, Cheyne-Stokes breathing, and extension rigidity in adults. When a reliable prognosis can be established that the patient is going to survive only as a vegetative wreck it is highly doubtful if the whole might of modern intensive therapy should be applied.