Decreased DNA Methylation of RGMA is Associated with Intracranial Hypertension After Severe Traumatic Brain Injury: An Exploratory Epigenome-Wide Association Study

Object It has recently been suggested that the degree of intracranial pressure (ICP) above the treatment goal can be estimated by the area under the curve (AUC) of ICP versus time in patients with severe traumatic brain injury (TBI). The objective of this study was to determine whether the calculated “ICP dose”—the ICP AUC—is related to mortality rate, outcome, and Marshall CT classification. Methods Of 135 patients (age range 1–82 years) with severe TBI treated during a 5-year period at the authors' institution, 113 patients underwent ICP monitoring (84%). Ninety-three patients with a monitoring time > 24 hours were included for analysis of ICP AUC calculated using the trapezoidal method. Computed tomography scans were assessed according to the Marshall TBI classification. Patients with Glasgow Outcome Scale scores at 6 months and > 3 years were separated into 2 groups based on outcome. Results Sixty patients (65%) had ICP values > 20 mm Hg, and 12 (13%) developed severe intracranial hypertension and died secondary to herniation. A multiple regression analysis adjusting for Glasgow Coma Scale score, age, pupillary abnormalities and Injury Severity Scale score demonstrated that the ICP AUC was a significant predictor of poor outcome at 6 months (p = 0.034) and of death (p = 0.035). However, it did not predict long-term outcome (p = 0.157). The ICP AUC was significantly higher in patients with Marshall head injury Categories 3 and 4 (24 patients) than in those with Category 2 (23 patients, p = 0.025) and Category 5 (46 patients, p = 0.021) TBIs using the worst CT scan obtained. Conclusions The authors found a significant relationship between the dose of ICP, the worst Marshall CT score, and patient outcome, suggesting that the AUC method may be useful in refining and improving the treatment of ICP in patients with TBI.

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Experimental model of intracranial hypertension with continuous multiparametric monitoring in swine

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20130126 ◽

2013 ◽

Vol 71 (10) ◽

pp. 802-806 ◽

Cited By ~ 4

Author(s):

Almir Ferreira de Andrade ◽

Matheus Schmidt Soares ◽

Gustavo Cartaxo Patriota ◽

Alessandro Rodrigo Belon ◽

Wellingson Silva Paiva ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Animal Model ◽

Brain Injury ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Severe Traumatic Brain Injury ◽

Transcranial Doppler ◽

Porcine Model ◽

Cerebral Oximetry ◽

Suitable Animal Model

Objective Intracranial hypertension (IH) develops in approximately 50% of all patients with severe traumatic brain injury (TBI). Therefore, it is very important to identify a suitable animal model to study and understand the pathophysiology of refractory IH to develop effective treatments. Methods We describe a new experimental porcine model designed to simulate expansive brain hematoma causing IH. Under anesthesia, IH was simulated with a balloon insufflation. The IH variables were measured with intracranial pressure (ICP) parenchymal monitoring, epidural, cerebral oximetry, and transcranial Doppler (TCD). Results None of the animals died during the experiment. The ICP epidural showed a slower rise compared with parenchymal ICP. We found a correlation between ICP and cerebral oximetry. Conclusion The model described here seems useful to understand some of the pathophysiological characteristics of acute IH.

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Hypertonic saline infusion for treating intracranial hypertension after severe traumatic brain injury

Critical Care ◽

10.1186/s13054-018-1963-7 ◽

2018 ◽

Vol 22 (1) ◽

Cited By ~ 8

Author(s):

Halinder S. Mangat

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Hypertension ◽

Hypertonic Saline ◽

Severe Traumatic Brain Injury ◽

Saline Infusion ◽

Hypertonic Saline Infusion

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Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury

Journal of Clinical Medicine ◽

10.3390/jcm9062000 ◽

2020 ◽

Vol 9 (6) ◽

pp. 2000

Author(s):

Shannon Cooper ◽

Cino Bendinelli ◽

Andrew Bivard ◽

Mark Parsons ◽

Zsolt J. Balogh

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Hypertension ◽

Severe Traumatic Brain Injury ◽

Injury Severity ◽

Intervention Group ◽

Small Sample ◽

Perfusion Computed Tomography ◽

Group I ◽

Second Tier

The role of invasive intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (STBI) remain unclear. Perfusion computed tomography (CTP) provides crucial information about the cerebral perfusion status in these patients. We hypothesised that CTP abnormalities would be associated with the severity of intracranial hypertension (ICH). To investigate this hypothesis, twenty-eight patients with STBI and ICP monitors were investigated with CTP within 48 h from admission. Treating teams were blind to these results. Patients were divided into five groups based on increasing intervention required to control ICH and were compared. Group I required no intervention above routine sedation, group II required a single first tier intervention, group III required multiple different first-tier interventions, group IV required second-tier medical therapy and group V required second-tier surgical therapy. Analysis of the results showed demographics and injury severity did not differ among groups. In group I no patients showed CTP abnormality, while patients in all other groups had abnormal CTP (p = 0.003). Severe ischaemia observed on CTP was associated with increasing intervention for ICH. This study, although limited by small sample size, suggests that CTP abnormalities are associated with the need to intervene for ICH. Larger scale assessment of our results is warranted to potentially avoid unnecessary invasive procedures in head injury patients.

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Predictors of intracranial hypertension in children undergoing ICP monitoring after severe traumatic brain injury

Child s Nervous System ◽

10.1007/s00381-020-04516-7 ◽

2020 ◽

Vol 36 (7) ◽

pp. 1453-1460

Author(s):

Darryl K. Miles ◽

Maria R. Ponisio ◽

Ryan Colvin ◽

David Limbrick ◽

Jacob K. Greenberg ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Hypertension ◽

Severe Traumatic Brain Injury ◽

Icp Monitoring ◽

Hypertension In Children

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Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring

Journal of Neurosurgery ◽

10.3171/2012.7.jns111816 ◽

2012 ◽

Vol 117 (4) ◽

pp. 729-734 ◽

Cited By ~ 103

Author(s):

Arash Farahvar ◽

Linda M. Gerber ◽

Ya-Lin Chiu ◽

Nancy Carney ◽

Roger Härtl ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Severe Traumatic Brain Injury ◽

Lower Mortality ◽

Icp Monitoring ◽

Improvement Program ◽

Severe Tbi ◽

Gcs Score

Object Evidence-based guidelines recommend intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury (TBI), but there is limited evidence that monitoring and treating intracranial hypertension reduces mortality. This study uses a large, prospectively collected database to examine the effect on 2-week mortality of ICP reduction therapies administered to patients with severe TBI treated either with or without an ICP monitor. Methods From a population of 2134 patients with severe TBI (Glasgow Coma Scale [GCS] Score <9), 1446 patients were treated with ICP-lowering therapies. Of those, 1202 had an ICP monitor inserted and 244 were treated without monitoring. Patients were admitted to one of 20 Level I and two Level II trauma centers, part of a New York State quality improvement program administered by the Brain Trauma Foundation between 2000 and 2009. This database also contains information on known independent early prognostic indicators of mortality, including age, admission GCS score, pupillary status, CT scanning findings, and hypotension. Results Age, initial GCS score, hypotension, and CT scan findings were associated with 2-week mortality. In addition, patients of all ages treated with an ICP monitor in place had lower mortality at 2 weeks (p = 0.02) than those treated without an ICP monitor, after adjusting for parameters that independently affect mortality. Conclusions In patients with severe TBI treated for intracranial hypertension, the use of an ICP monitor is associated with significantly lower mortality when compared with patients treated without an ICP monitor. Based on these findings, the authors conclude that ICP-directed therapy in patients with severe TBI should be guided by ICP monitoring.

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