ObjectiveTo study the current intensive care management of patients with severe head injury (defined as a Glasgow Coma Scale score of <or=to8) in neurosurgical referral centers in the United Kingdom (UK) and Ireland.Data CollectionA questionnaire was sent to the directors of the 44 neurosurgical referral units identified from the UK Medical Directory. After 4 wks, a copy of the questionnaire was sent to all nonresponders, with a cover letter urging them to respond. The aim was to collect data regarding the characteristics of the intensive care units (ICU), sedation, monitoring modalities used, the treatment of intracranial hypertension, and general care of severely head-injured patients.Data Extraction100 patients with severe head injury.50% of the patients in 94% and 77% of the centers, respectively, intracranial pressure was only monitored routinely in 57% of the centers. Jugular venous bulb oximetry, transcranial Doppler ultrasonography, electroencephalography, and near-infrared spectroscopy were rarely used.Nearly all centers used propofol and midazolam for sedation, with morphine, fentanyl, and alfentanil as the main analgesics.Muscle relaxation was commonly used, with 40% of the centers employing it in 100% of their patients. Atracurium and vecuronium were the most commonly used agents.Only 68% of the centers had a protocol for the treatment of intracranial hypertension.Although hyperventilation to a PaCO2of 26 to 30 torr (3.5 to 4.0 kPa) was the norm in the majority of centers (56%), two centers aimed for PaCO260 mm Hg. Mild hypothermia was rarely used and 14% of the centers continued to use corticosteroids for the treatment of intracranial hypertension as a result of head trauma.ConclusionWe conclude that there are wide variations in the management of the severely head-injured patient in the UK and Ireland. Some of the therapies employed are not supported by available research findings. Rationalization (using rational management, i.e., based on good evidence) of the intensive care management of severe head injury with the development of widely accepted guidelines may result in an improvement in the quality of care of the head-injured patient.(Crit Care Med 1996; 24:1743-1748)