Midazolam is effective in controlling intracranial pressure in severe traumatic brain injury

Abstract

Context: Traumatic brain injuries present a grave public health problem in developing countries. Guidelines suggest that neuromuscular blockade (NMB) should be avoided in severe head injury. Midazolam is an affordable option for sedation when resources are limited. Aims: We proposed to study whether midazolam as a sedative agent in severe head injury achieved adequate control of intracranial pressure (ICP) and reduced the need for NMB. Settings and Design: A prospective observational study was conducted in 96 consecutive patients with severe head injury needing ventilation in the neurosurgical intensive care unit (ICU) of our hospital. Subjects and Methods: A modification of “Guidelines for the management of severe head injury, Brain Trauma Foundation” was used to control ICP in these patients. A ventricular catheter was inserted for ICP monitoring and an ICP <20 mm Hg was targeted by cerebrospinal fluid venting, mannitol and increasing the level of sedation with midazolam up to 0.15 mg/kg/h. It was planned to monitor the ICP for a minimum of 48 hours. Results: Mean duration of ICP monitoring was 35.80 ± 23.08 hours. In 63 of the 96 patients, the ICP remained ≤20 mmHG in patients on Midazolam infusion without NMB (65.6%). Conclusions: Sedation with midazolam can be used in a severe head injury to control ICP and to reduce the need for NMB, particularly in resource-poor settings.

Keywords

• intracranial pressure control
• midazolam
• severe traumatic brain injury