RESCUE ICP COMMENTS

Why not a primary decompressive craniectomy?

Congratulations for Rescue ICP. As a physician and neurosurgeon,to treat refractory intracranial hypertension is always a challenge. Patients with subdural hematomas whose difference between the septal deviation and the thickness of the hematoma is greater than 3mm, suggests edema and swelling associated. In Brazil, this difference is called Zumkeller Index in honor to the author of the article. A primary decompressive craniectomy is the neurosurgical approach widespread in this case, especially by Professor Ruy Monteiro. In supplementary appendix, table S3, 6 of 26 (23%) patients undergoing craniotomy patients had subdural hematoma and required decompression. Perhaps this group of patients could benefit from a primary decompression instead of a secondary decompression proposed by the article, utilizing Zumkeller Index. Perhaps Marshall IV diffuse injury had a better outcome with a primary decompressive craniectomy since the vast majority of these patients will have refractory intracranial hypertension. The Brazilian Neurosurgery Society, on behalf of Neurocritical Care Department congratulate the study and suggests the analysis of groups with subdural and Marshall IV.

NEJM RESCUE ICP