Early intracranial pressure studies in gunshot wounds of the brain.

Intracranial pressure (ICP) was recorded following gunshot wounds of the brain in 20 patients, and in 11 of them within an hour of injury, during resuscitation. In six who were bleeding profusely, both ICP and blood pressure were low, and they required massive transfusion, with successful outcome in two. Four others presented with small wounds and high ICP. Others, with minimal damage, had "normal" pressures, but this could be affected adversely by coughing, struggling, and minor degrees of respiratory obstruction. Immediate endotracheal intubation, muscle relaxation, and mechanical ventilation prevented such deterioration. Controlled ventilation was continued postoperatively and seemed to control ICP in survivors. It is suggested that the very labile post-traumatic condition of such patients can be improved by adequate resuscitation, immediate intubation, and controlled ventilation; ICP monitoring is valuable pre- and postoperatively in assessing treatment.