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Even if an operation to remove a blood clot is not required, people who have suffered a severe head injury can develop brain swelling and may need to be admitted to a neurosurgical intensive care unit and spend some time on a ventilator. Once in the intensive care unit they will probably have a tube or wire placed inside their head to measure the pressure inside the skull (intracranial pressure, or ICP). If the brain starts to swell, as it can do after an injury, this device will give an early warning to the neurosurgeon, who may then need to give treatment to relieve the pressure. Anaesthetic drugs are frequently given to keep people sedated while they are on the intensive care unit.

What are all the machines for?
The ventilator will do the work of breathing for the patient. It does this by pushing the right amount of air into the lungs to mimic their own breathing. A tube is passed down into the lungs to allow the air in and out, and this tube can stay there for many days without causing problems. Occasionally a tube is required for longer periods, in which case it is placed directly into the windpipe in the neck (tracheostomy). This can usually be done in the intensive care unit, but it may need to be done in the operating theatre. The other machines which you may see in the intensive care unit are used to monitor the person’s heart rate, blood pressure, temperature and other bodily functions, all of which may be altered by the effects on the brain of a head injury. Appropriate treatment will then be given, which may include fluids and drugs being given into a vein.

Can I speak to them?
It is important that family and friends treat the person as normally as possible. This may be very difficult to do in these circumstances, especially when they cannot respond. Do your best to ignore all the machines and talk to them about normal things, such as family matters or television, and hold their hand or touch them. Because of the injury, the anaesthetic drugs that they will have been given and the fact that their level of consciousness is likely to vary, it is impossible to tell how much will be getting through, but it may help them and it could also help you and other family members or friends.

How long will they be given sedatives?
People are likely to be given sedative drugs as long as they are on a entilator in the intensive care unit. Sedation can make it more difficult for doctors to assess the patient, but the drugs will only be stopped when they feel it is safe to do so. This means that once stable measurements (normal pressure inside the head, blood pressure, lung function, reflex responses and so on) have been achieved, the drugs can be stopped. If a person has been on sedatives for several days it may take some time for their effects to wear off.

If an operation has been done will further surgery be required?
This is unlikely. Even if the pressure in the head starts to rise, surgery is not often required. If there is an increase in pressure the neurosurgeon will most probably order another CT scan to check that there has been no further bleeding or swelling, and will inform the family of the findings and any necessary treatment.

How can the pressure be treated?
The neurosurgeon will know what sort of pressure rise is significant and when to start treatment. Sometimes the pressure will simply come down again on its own without any need for treatment. If a pressure rise is considered significant there are fluids and drugs that can be given via a drip in the vein to reduce the swelling of the brain, which will in turn reduce the pressure.

What if the pressure continues to rise?
This is a very serious situation, but fortunately an uncommon one. If the pressure on the brain continues to rise there may be nothing more the neurosurgeon can do, and the person may not recover.