Intracranial pressure in children and adolescents with severe head injuries.

Long-term ICP monitoring was carried out in 53 children and adolescents with severe head injuries. 36 of them exhibited bilateral decerebrate posturing and 13 bilateral pupil unresponsiveness. The highest ICP levels never exceeded 10 mmHg in 3 patients, ranged between 11 and 20 mmHg in 12 and between 21 and 50 in 16. Fifteen patients showed sustained intracranial hypertension over 50 mmHg. Six patients died from fulminating intracranial hypertension and 21 died later (average survival 10.1 days). Five patients remained severely disabled and 21 satisfactorily recovered. Seven patients with the highest degrees of intracranial hypertension survived, in all of them ICP reached its peak more than 72 hours after injury. Early hypertension exceeding 50 mmHg always proved fatal. Four patients with mild hypertension but with very high elastance on P/V tests died. Although children and adolescents may withstand higher degrees of intracranial hypertension than adults, outcome remains poor despite active therapy in ICU patients with deep stabilised coma.