From the Research
Immediate critical care for a patient with subdural empyema requires prompt neurosurgical intervention for drainage of the purulent collection, combined with high-dose intravenous antibiotics, as evidenced by the most recent study 1. The patient should undergo emergency surgical evacuation via craniotomy or burr hole drainage to decompress the brain and remove the infected material. Empiric broad-spectrum antibiotic therapy should be initiated immediately, typically including vancomycin (15-20 mg/kg IV every 8-12 hours) plus a third-generation cephalosporin such as ceftriaxone (2g IV every 12 hours) and metronidazole (500mg IV every 8 hours) to cover common pathogens including streptococci, staphylococci, and anaerobes, as supported by 1. Once culture results are available, antibiotics should be narrowed accordingly. The patient requires admission to an intensive care unit for close neurological monitoring, management of increased intracranial pressure, seizure prophylaxis with levetiracetam (500-1000mg IV twice daily), and supportive care. Corticosteroids (dexamethasone 4-10mg IV every 6 hours) may be considered to reduce cerebral edema, though this remains controversial. Antibiotic therapy typically continues for 4-6 weeks. Rapid intervention is critical as subdural empyema represents a neurosurgical emergency with high mortality if not promptly treated, due to the risk of rapid neurological deterioration from mass effect, increased intracranial pressure, and spread of infection to adjacent brain tissue, as highlighted in 1.
Some key points to consider in the management of subdural empyema include:
- Prompt diagnosis using contrast-enhanced brain MRI, as recommended by 1
- Urgent neurosurgical intervention, including craniotomy and evacuation, as emphasized by 1
- Postoperative broad-spectrum antibiotic therapy, as supported by 1
- A multidisciplinary approach to care, involving neurosurgery, infectious disease, and critical care specialists, as suggested by 1
It is essential to prioritize the most recent and highest-quality evidence, such as 1, when making decisions about the critical care of patients with subdural empyema, to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.