Intrakraniell trycksänkande behandling vid akut bakteriell meningit ökade överlevnaden
Sammanfattning
To evaluate the efficacy of intracranial pressure (ICP)-targeted treatment, compared to standard intensive care, in adults with community acquired acute bacterial meningitis (ABM) and severely impaired consciousness, a
prospectively designed intervention-control comparison study was performed. Included were patients with confirmed ABM and severely impaired mental status on admission. Fifty-two patients, given ICP-targeted treatment at a neuro-
intensive care unit, and 53 control cases, treated with conventional intensive care, were included. All patients received intensive care with mechanical ventilation, sedation, antibiotics and corticosteroids according to current guidelines.
ICP-targeted treatment was performed in the intervention group, aiming at ICP <20 mmHg and a cerebral perfusion pressure of >50 mmHg. The mortality was significantly lower in the intervention group compared to controls, 5/52 (10%)
versus 16/53 (30%). Furthermore, only 17 patients (32%) in the control group fully recovered, compared to 28 (54%) in the intervention group. Early neuro-intensive care using ICP-targeted therapy reduces mortality and improves the overall
outcome in adult patients with ABM and severely impaired mental status on admission.