Characterizing the Dose-Response Relationship between Mannitol and Intracranial Pressure in Traumatic Brain Injury Patients Using a High-Frequency Physiological Data Collection System

2008 ◽  
Vol 25 (4) ◽  
pp. 291-298 ◽  
Author(s):  
Marco D. Sorani ◽  
Diane Morabito ◽  
Guy Rosenthal ◽  
Kathleen M. Giacomini ◽  
Geoffrey T. Manley
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Data Collection ◽  
Dose Response ◽  
High Frequency ◽  
Physiological Data ◽  
Response Relationship ◽  
Collection System ◽  
Dose Response Relationship

scholarly journals Intracranial pressure–based barbiturate coma treatment in children with refractory intracranial hypertension due to traumatic brain injury

2020 ◽  
Vol 25 (4) ◽  
pp. 375-383 ◽  
Author(s):  
Fartein Velle ◽  
Anders Lewén ◽  
Timothy Howells ◽  
Per Enblad ◽  
Pelle Nilsson
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Scale Score ◽  
Effective Means ◽  
Physiological Data ◽  
Barbiturate Coma ◽  
Severe Condition ◽  
Long Term Outcome

OBJECTIVERefractory intracranial pressure (ICP) hypertension following traumatic brain injury (TBI) is a severe condition that requires potentially harmful treatment strategies such as barbiturate coma. However, the use of barbiturates may be restricted due to concerns about inducing multiorgan system complications related to the therapy. The purpose of this study was to evaluate the outcome and occurrence of treatment-related complications to barbiturate coma treatment in children with refractory intracranial hypertension (RICH) due to TBI in a modern multimodality neurointensive care unit (NICU).METHODSThe authors conducted a retrospective cohort study of 21 children ≤ 16 years old who were treated in their NICU between 2005 and 2015 with barbiturate coma for RICH following TBI. Demographic and clinical data were acquired from patient records and physiological data from digital monitoring system files.RESULTSThe median age of these 21 children was 14 years (range 2–16 years) and at admission the median Glasgow Coma Scale score was 7 (range 4–8). Barbiturate coma treatment was added due to RICH at a median of 46 hours from trauma and had a median duration of 107 hours. The onset of barbiturate coma resulted in lower ICP values, lower pulse amplitudes on the ICP curve, and decreased amount of A-waves. No major disturbances in blood gases, liver and kidney function, or secondary insults were observed during this period. Outcome 1 year later revealed a median Glasgow Outcome Scale score of 5 (good recovery), however on the King’s Outcome Scale for Childhood Head Injury, the median was 4a (moderate disability).CONCLUSIONSThe results of this study indicate that barbiturate coma, when used in a modern NICU, is an effective means of lowering ICP without causing concomitant severe side effects in children with RICH and was compatible with good long-term outcome.

scholarly journals Probabilistic Prediction of Increased Intracranial Pressure in Patients With Severe Traumatic Brain Injury

2021 ◽  
Author(s):  
Priyantha Wijayatunga ◽  
Lars-Owe D Koskinen ◽  
Nina Sundström
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Series Data ◽  
Physiological Data ◽  
Proper Actions ◽  
Brain Functions ◽  
Enhancement Method ◽  
Severe Tbi ◽  
Leave One Out

Abstract Background: Traumatic brain injury (TBI) causes temporary or permanent alteration in brain functions. Generally, at intensive care units (ICU), intracranial pressure (ICP) is monitored and treated to avoid increases in ICP with associated secondary insults and poor clinical outcome. The aim of this study was to develop and evaluate a model which could predict future ICP levels of individual patients during their treatment in the ICU, and thus help the treating clinician to take proper actions before secondary injuries occure. Methods: A simple, explainable, probabilistic Markov model was developed for the prediction task of ICP≥20 mmHg. Predictions were made for consecutive 10-minute intervals during the following hour, based on the preceding hour of ICP data. An easily implementable enhancement method was also developed and applied to compensate for imbalance in the data. The model was evaluated in a randomized and leave-one-out fashion on data from 29 patients with severe TBI. Results: With random data selection from all patients (80/20% training/testing) and including the new enhancement method, the specificity of the model was high (93.9-95.0) and the sensitivity was good to high (72.7-87.1). Levels were similar (specificity 90.1-95.3 and sensitivity 73.0-88.7) when the model was trained by the leave-one-out method and evaluated on individual subjects. Conclusion: The new model predicted increased levels of ICP in a reliable manner and the enhancement method to compensate for imbalanced data further improved the predictions. This lays the foundation for development of a bedside warning system designed to proactively avoid increased ICP levels in patients with severe TBI. Further advantages are the straightforward expandability of the model, enabling inclusion of other time series data and/or static parameters, making future studies of predictive strength based on combinations of physiological data possible. Next step is to evaluate the model on a larger patient material and to include other parameters apart from ICP.

Dose–response relationship of mannitol and intracranial pressure: a metaanalysis

2008 ◽  
Vol 108 (1) ◽  
pp. 80-87 ◽  
Author(s):  
Marco D. Sorani ◽  
Geoffrey T. Manley
Keyword(s):  
Intracranial Pressure ◽  
Dose Response ◽  
Statistical Significance ◽  
Clinical Importance ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Treatment Protocols ◽  
Important Relationship ◽  
Significant Difference ◽  
Relationship Of

Object Brain edema can increase intracranial pressure (ICP), potentially leading to ischemia, herniation, and death. Edema and elevated ICP are often treated with osmotic agents to remove water from brain tissue. Mannitol is the osmotic diuretic most commonly used in the intensive care unit; however, despite its clinical importance, treatment protocols vary from center to center, and the dose–response relationship is not understood. The goal of this metaanalysis was to aggregate and analyze data from studies in which authors have described the dose–response relationship between mannitol and ICP. Methods The authors identified 18 studies that quantitatively characterized the dose–response relationship of mannitol and ICP. We also examined study designs and mannitol administration protocols. Results Meta-regression found a weak linear relationship between change in ICP (ΔICP) and dose (ΔICP = 6.6 × dose − 1.1; p = 0.27, R2 = 0.05). The lack of statistical significance could reflect the variation in protocols among studies and the variation in patients both within and among studies. However, the authors found a highly significant difference (p < 0.001) in decrease in ICP when the initial ICP was higher or lower than 30 mm Hg. Nonlinear regression suggested that ICP decrease is greatest shortly after mannitol is given (R2 = 0.63). Finally, the authors found that recent studies tend to include fewer patients and set a lower ICP threshold for mannitol administration but report more parameters of interest; the duration of mannitol's effect was the most frequently unreported parameter. Conclusions Despite its clinical importance, the determination of the mannitol dose–response curve continues to be challenging for many reasons. This metaanalysis highlights the need for a consensus of methods and results required to determine this important relationship.

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

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1220-1231 ◽  
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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