Analysis of the Relationship Between Intracranial Pressure Pulse Waveform and Outcome in Traumatic Brain Injury

External ventricular drainage (EVD) is widely used in patients with a traumatic brain injury (TBI). However, the EVD weaning trial protocol varies and insufficient studies focus on the intracranial pressure (ICP) during the weaning trial. We aimed to establish the relationship between ICP during an EVD weaning trial and the outcomes of TBI. We enrolled 37 patients with a TBI with an EVD from July 2018 to September 2019. Among them, 26 were allocated to the favorable outcome group and 11 to the unfavorable outcome group (death, post-traumatic hydrocephalus, persistent vegetative state, and severe disability). Groups were well matched for sex, pupil reactivity, admission Glasgow Coma Scale score, Marshall computed tomography score, modified Fisher score, intraventricular hemorrhage, EVD days, cerebrospinal fluid output before the weaning trial, and the complications. Before and during the weaning trial, we recorded the ICP at 1-hour intervals to calculate the mean ICP, delta ICP, and ICP burden, which was defined as the area under the ICP curve. There were significant between-group differences in the age, surgery types, and intensive care unit days (p=0.045, p=0.028, and p=0.004, respectively). During the weaning trial, 28 (75.7%) patients had an increased ICP. Although there was no significant difference in the mean ICP before and during the weaning trial, the delta ICP was higher in the unfavorable outcome group (p=0.001). Moreover, patients who experienced death and hydrocephalus had a higher ICP burden, which was above 20 mmHg (p=0.016). Receiver operating characteristic analyses demonstrated the predictive ability of these variables (area under the curve AUC=0.818 [p=0.002] for delta ICP and AUC=0.758 [p=0.038] for ICP burden>20 mmHg). ICP elevation is common during EVD weaning trials in patients with TBI. ICP-related parameters, including delta ICP and ICP burden, are significant outcome predictors. There is a need for larger prospective studies to further explore the relationship between ICP during EVD weaning trials and TBI outcomes.

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The Relationship Between Intracranial Pressure and Brain Oxygenation in Children With Severe Traumatic Brain Injury

Neurosurgery ◽

10.1227/neu.0b013e318243fc59 ◽

2011 ◽

Vol 70 (5) ◽

pp. 1220-1231 ◽

Cited By ~ 26

Author(s):

Ursula K. Rohlwink ◽

Eugene Zwane ◽

A. Graham Fieggen ◽

Andrew C. Argent ◽

Peter D. le Roux ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Severe Traumatic Brain Injury ◽

High Frequency ◽

Strong Relationship ◽

Red Cross ◽

Brain Oxygenation ◽

Data Points ◽

The Relationship

Abstract BACKGROUND: Intracranial pressure (ICP) monitoring is a cornerstone of care for severe traumatic brain injury (TBI). Management of ICP can help ensure adequate cerebral blood flow and oxygenation. However, studies indicate that brain hypoxia may occur despite normal ICP and the relationship between ICP and brain oxygenation is poorly defined. This is particularly important for children in whom less is known about intracranial dynamics. OBJECTIVE: To examine the relationship between ICP and partial pressure of brain tissue oxygen (PbtO2) in children with severe TBI (Glasgow Coma Scale score ⩽8) admitted to Red Cross War Memorial Children's Hospital, Cape Town. METHODS: The relationship between time-linked hourly and high-frequency ICP and PbtO2 data was examined using correlation, regression, and generalized estimating equations. Thresholds for ICP were examined against reduced PbtO2 using age bands and receiver-operating characteristic curves. RESULTS: Analysis using more than 8300 hourly (n = 75) and 1 million high-frequency data points (n = 30) demonstrated a weak relationship between ICP and PbtO2 (r = 0.05 and r = 0.04, respectively). No critical ICP threshold for low PbtO2 was identified. Individual patients revealed a strong relationship between ICP and PbtO2 at specific times, but different relationships were evident over longer periods. CONCLUSION: The relationship between ICP and PbtO2 appears complex, and several factors likely influence both variables separately and in combination. Although very high ICP is associated with reduced PbtO2, in general, absolute ICP has a poor relationship with PbtO2. Because reduced PbtO2 is independently associated with poor outcome, a better understanding of ICP and PbtO2 management in pediatric TBI seems to be needed.

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The Relationship of Triphasic Waves with Intracranial Pressure as a Possible Prognostic Marker in Traumatic Brain Injury

Case Reports in Neurological Medicine ◽

10.1155/2017/4742026 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Nakul Katyal ◽

Aarti Sarwal ◽

Pravin George ◽

Biswajit Banik ◽

Christopher R. Newey

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Prognostic Marker ◽

Prognostic Significance ◽

Nonconvulsive Seizures ◽

Severe Tbi ◽

Relationship Of ◽

The Relationship

Background.Continuous electroencephalography (CEEG) monitoring is used for detection of convulsive and nonconvulsive seizures and assessing the degree of encephalopathy in critically ill patients. A commonly seen encephalopathic pattern on CEEG is generalized periodic discharges with triphasic wave (TW) morphology. The underlying role and prognostic significance of TW in relationship to intracranial pressure (ICP) remain unknown. We present a case highlighting the relationship of TW with ICP in a case with severe traumatic brain injury (TBI).Method.Case report.Results.A patient with severe TBI and no underlying metabolic abnormalities was admitted to the neurocritical care unit. TW were seen on CEEG. The TW diminished during episodes of intracranial hypertension but reappeared with reduction of the intracranial pressure.Conclusion.This study highlights a possible favorable prognostic marker of finding TW in a patient with intracranial hypertension. We have proposed a preliminary understanding of the relationship between TW and intracranial hypertension, which may be helpful in formulating future studies involving larger cohorts.

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The Relationship between Serum Sodium, Serum Osmolality, and Intracranial Pressure in Patients with Traumatic Brain Injury Treated with Hyperosmolar Therapy

The American Surgeon ◽

10.1177/00031348211058627 ◽

2021 ◽

pp. 000313482110586

Author(s):

Paige Farley ◽

Daniel Salisbury ◽

John R Murfee ◽

Colin T Buckley ◽

Catherine N Taylor ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Serum Sodium ◽

Serum Osmolality ◽

Clinical Markers ◽

Icp Monitoring ◽

Hyperosmolar Therapy ◽

Time Points ◽

The Relationship

Background Treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI) is controversial. Hyperosmolar therapy is used to prevent cerebral edema in these patients. Many intensivists measure direct correlates of these agents—serum sodium and osmolality. We seek to provide context on the utility of using these measures to estimate ICP in TBI patients. Materials and Methods Patients admitted with TBI who required ICP monitoring from 2008 to 2012 were included. Intracranial pressure, serum sodium, and serum osmolality were assessed prior to hyperosmotic therapy then at 6, 12, 18, 24, 48, and 72 hours after admission. A linear regression was performed on sodium, osmolality, and ICP at baseline and serum sodium and osmolality that corresponded with ICP for 6-72-hour time points. Results 136 patients were identified. Patients with initial measures were included in the baseline analysis (n = 29). Patients who underwent a craniectomy were excluded from the 6-72-hour analysis (n = 53). Initial ICP and serum sodium were not significantly correlated (R2 .00367, P = .696). Initial ICP and serum osmolality were not significantly correlated (R2 .00734, P = .665). Intracranial pressure and serum sodium 6-72 hours after presentation were poorly correlated (R2 .104, P < .0001), as were ICP and serum osmolality at 6-72 hours after presentation (R2 .116, P < .0001). Discussion Our results indicate initial ICP is not correlated with serum sodium or osmolality suggesting these are not useful initial clinical markers for ICP estimation. The association between ICP and serum sodium and osmolality after hyperosmolar therapy was poor, thus may not be useful as surrogates for direct ICP measurements.

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Kajian Konsep Lund dan Konsep Rosner untuk Tatalaksana Cedera Otak Traumatik Berat

Jurnal Neuroanestesi Indonesia ◽

10.24244/jni.v9i2.248 ◽

2020 ◽

Vol 9 (2) ◽

pp. 126-40

Author(s):

Fitri Sepviyanti Sumardi ◽

Iwan Abdul Rachman ◽

Sri Rahardjo

Keyword(s):

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

Intracranial Pressure ◽

Brain Trauma ◽

Brain Trauma Foundation ◽

European Brain ◽

Severe Tbi ◽

The Relationship

Tatalaksana pasien dengan cedera otak traumatik (COT) berat mengalami perubahan berkesinambungan selama 30 tahun terakhir. Tatalaksana yang diarahkan di unit perawatan intensif (intensive care unit/ICU) mengacu pada tatalaksana klinis sebagai titik akhir terapi utama, bertujuan untuk mempertahankan variabel fisiologis tertentu secara ketat dalam rentang target yang telah ditentukan. Satu alternatif terhadap terapi konvensional ini adalah konsep Lund yang mengutamakan penurunan tekanan mikrovaskular. Konsep Lund termasuk suatu strategi target volume untuk mengendalikan tekanan intrakranial, berasal dari Universitas Lund Swedia, lebih dari 27 tahun yang lalu dan tetap masih kontroversi sampai saat ini. Sejak tahun 1996, American Brain Trauma Foundation dan European Brain Injury Consortium, yang mengacu pada konsep Rosner, telah menerbitkan dan memperbarui panduan untuk tatalaksana cedera otak traumatik. Para ahli sangat menyadari adanya patologi intrakranial multifaktorial yang terlihat pada pasien COT berat dan kompleksitas mekanisme cedera otak sekunder setelah trauma primer, akan menemukan bahwa revisi ini sulit untuk dipahami. Hubungan antara peningkatan tekanan intrakranial (TIK) dan hasil luaran klinis yang lebih buruk sudah terbukti. Menyederhanakan fisiologi otak setelah COT berat ke strategi tatalaksana pasien bedasarkan ambang batas adalah berkaitan erat dengan hubungan interaksi komplek antara: peningkatan TIK, aliran darah otak, dan metabolisme otak. Review of Lund Concept and Rosner Concept for Therapy of Severe Traumatic Brain InjuryAbstractThe management of patients with severe traumatic brain injury (TBI) has undergone continuous changes over the past 30 years. Management directed at the intensive care unit (ICU) refers to clinical management as the main end point of therapy, aiming to maintain certain physiological variables strictly within a predetermined target range. One alternative to this conventional therapy is the Lund concept which prioritizes the reduction of microvascular pressure. The concept of Lund includes a volume target strategy for controlling intracranial pressure, from Lund University in Sweden, more than 27 years ago and remains controversial to date. Since 1996, the American Brain Trauma Foundation and the European Brain Injury Consortium, which refers to the Rosner concept, have published and updated guidelines for the management of traumatic brain injury. Experts are well aware of the multifactorial intracranial pathology seen in severe TBI patients and the complexity of the mechanism of secondary brain injury after primary trauma will find that this revision is difficult to understand. The relationship between increased intracranial pressure (ICP) and worse clinical outcome has been proven. Simplifying the physiology of the brain after severe TBI to the patient's management strategy based on the threshold is closely related to the relationship between complex interactions: increased ICP, cerebral blood flow (CBF), and brain metabolism.

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Noninvasive Evaluation of Intracranial Pressure by Transcranial Doppler Ultrasound in Patients With Traumatic Brain Injury

10.21203/rs.3.rs-44792/v1 ◽

2020 ◽

Author(s):

Tao Chang ◽

Yanlong Yang ◽

Zhen Qian ◽

Qingbao Guo ◽

Lihong Li

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Doppler Ultrasound ◽

Transcranial Doppler ◽

Strong Correlation ◽

Transcranial Doppler Ultrasound ◽

The Relationship ◽

Different Levels

Abstract Background As a noninvasive monitoring measure, transcranial Doppler ultrasound (TCD) has been widely used to monitor the secondary brain injury in patients with traumatic brain injury (TBI). There are different physiological theories on the noninvasive assessment of intracranial pressure by TCD parameters, including ONSD and PI, which may cause that the change of ONSD and PI is not always synchronous with that of ICP. Therefore, the objective of this study was to investigate the relationship between PI or ONSD and ICP at different levels or in different periods after the operation, and the ability of prediction intracranial hypertension with these parameters in patients with TBI. Methods The clinical data of 68 patients with TBI were retrospectively analyzed. The statistical correlation analysis was performed to investigate the relationship between the PI or ONSD and ICP one week after the operation. Besides, the area under the curve (AUC) of ONSD or PI alone or a combination of them was calculated to determine the ability of intracranial hypertension. Results 1. There was a correlation between ONSD and ICP ≥ 20 mmHg (r = 0.665, p < 0.001), ICP < 20 mmHg (r = 0.358, p = 0.006). The correlation still remained at ONSD ≥ 5 mm (r = 0.644, p < 0.001), but no correlation at ONSD < 5 mm (p = 0.137). 2. There was a strong correlation between PI and ICP at ICP of 15–20 mmHg (r = 0.705, p < 0.001), and ICP ≥ 20 mmHg (r = 0.716, p < 0.001). Nevertheless, it revealed a weak correlation at PI < 1.2 (r = 0.271, p = 0.021), PI ≥ 1.2 (r = 0.350, p = 0.020). In different period after the operation, there was a moderate correlation between ICP and PI on days 3, 4, and 5 (r = 0.508, p < 0.001), a strong correlation on days 6 and 7 after the operation (r = 0.645, p < 0.001). 3. For prediction intracranial hypertension with PI ≥ 1.2 or ONSD ≥ 5 mm alone or a combination of ONSD ≥ 5 mm and PI ≥ 1.2, the AUC value was 0.729 (p < 0.001), 0.900 (p < 0.001), and 0.943 (p < 0.001), respectively. Conclusion The correlation between the parameters of TCD, including ONSD and PI, and invasive ICP vary at different levels of ICP and in different periods in patients with TBI post-operation. It could also allow for a more accurate prediction of elevated intracranial pressure with a combination of ONSD ≥ 5 mm and PI ≥ 1.2.

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Acute clinical grading in pediatric severe traumatic brain injury and its association with subsequent intracranial pressure, cerebral perfusion pressure, and brain oxygenation

Neurosurgical FOCUS ◽

10.3171/foc.2008.25.10.e4 ◽

2008 ◽

Vol 25 (4) ◽

pp. E4 ◽

Cited By ~ 13

Author(s):

Anthony A. Figaji ◽

Eugene Zwane ◽

A. Graham Fieggen ◽

Jonathan C. Peter ◽

Peter D. Leroux

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Cerebral Perfusion Pressure ◽

Severe Traumatic Brain Injury ◽

Cerebral Perfusion ◽

Perfusion Pressure ◽

Brain Oxygenation ◽

Clinical Scores ◽

The Relationship

Object The goal of this paper was to examine the relationship between methods of acute clinical assessment and measures of secondary cerebral insults in severe traumatic brain injury in children. Methods Patients who underwent intracranial pressure (ICP), cerebral perfusion pressure (CPP), and brain oxygenation (PbtO2) monitoring and who had an initial Glasgow Coma Scale score, Pediatric Trauma Score, Pediatric Index of Mortality 2 score, and CT classification were evaluated. The relationship between these acute clinical scores and secondary cerebral insult measures, including ICP, CPP, PbtO2, and systemic hypoxia were evaluated using univariate and multivariate analysis. Results The authors found significant associations between individual acute clinical scores and select physiological markers of secondary injury. However, there was a large amount of variability in these results, and none of the scores evaluated predicted each and every insult. Furthermore, a number of physiological measures were not predicted by any of the scores. Conclusions Although they may guide initial treatment, grading systems used to classify initial injury severity appear to have a limited value in predicting who is at risk for secondary cerebral insults.

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