Comment The bottom line of this complex clinical study would seem to be that elevated ICP after severe head injury is a close correlate of mortality. Among the 25 patients in whom treatment (conventional, barbiturate, or conventionil crossover to barbiturate) successfully lowered ICP, 23 were alive at 30 days while among the 48 patients without ICP control 40 were dead at N days. This should not be too surprising to mo* physicians who deal with this type of patient On the other hand it emphasizes that an elevated ICP in itself is worthy of the most aggressive trert-ment available. Perhaps this is one time where beneficial alterations of a process variable, in mil case ICP, will predict a real change in the oat-come variable, survival. Richard F. Davis, M.D.
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Eisenberg et al. (1989) studied this question.