Patients Who Benefit from Intracranial Pressure Monitoring without Cerebrospinal Fluid Drainage After Severe Traumatic Brain Injury

Neurosurgery ◽  
2018 ◽  
Vol 85 (2) ◽  
pp. 231-239 ◽  
Author(s):  
Abhijit Lele ◽  
Nithya Kannan ◽  
Monica S Vavilala ◽  
Deepak Sharma ◽  
Mahmud Mossa-Basha ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Intraventricular Hemorrhage ◽  
Cerebrospinal Fluid Drainage ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Severe Tbi

AbstractBACKGROUNDIndia has a high traumatic brain injury (TBI) burden and intracranial pressure monitoring (ICP) remains controversial but some patients may benefit.OBJECTIVETo examine the association between ICP monitor placement and outcomes, and identify Indian patients with severe TBI who benefit from ICP monitoringMETHODSWe conducted a secondary analysis of a prospective cohort study at a level 1 Indian trauma center. Patients over 18 yr with severe TBI (admission Glasgow coma scale score < 8) who received tracheal intubation for at-least 48 h were examined. Propensity-based analysis using inverse probability weighting approach was used to examine ICP monitor placement within 72 h of admission and outcomes. Outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) score at discharge, 3, 6, and 12 mo. Death, vegetative, or major impairment defined unfavorable outcome.RESULTSThe 200 patients averaged 36 [18 to 85] yr of age and average injury severity score of 31.4 [2 to 73]. ICP monitors were placed in 126 (63%) patients. Patients with ICP monitor placement experienced lower in-hospital mortality (adjusted relative risk [aRR]; 0.50 [0.29, 0.87]) than patients without ICP monitoring. However, there was no benefit at 3, 6, and 12 mo. With ICP monitor placement, absence of cerebral edema (aRR 0.54, 95% confidence interval 0.35-0.84), and absence of intraventricular hemorrhage (aRR 0.52, 95% confidence interval 0.33-0.82) were associated with reduced unfavorable outcomes.CONCLUSIONICP monitor placement without cerebrospinal fluid drainage within 72 h of admission was associated with reduced in-patient mortality. Patients with severe TBI but without cerebral edema and without intraventricular hemorrhage may benefit from ICP monitoring.

scholarly journals Relationship between Intracranial Pressure Monitoring and Outcomes in Severe Traumatic Brain Injury Patients

2011 ◽  
Vol 39 (6) ◽  
pp. 1043-1050 ◽  
Author(s):  
S. Haddad ◽  
A. S. Aldawood ◽  
A. Alferayan ◽  
N. A. Russell ◽  
H. M. Tamim ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Mechanical Ventilation ◽  
Intracranial Pressure ◽  
Hospital Mortality ◽  
Icp Monitoring ◽  
Icu Mortality ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
Significant Difference ◽  
Severe Tbi

Intracranial pressure (ICP) monitoring is recommended in patients with a severe traumatic brain injury (TBI) and an abnormal computed tomography (CT) scan. However, there is contradicting evidence about whether ICP monitoring improves outcome. The purpose of this study was to examine the relationship between ICP monitoring and outcomes in patients with severe TBI. From February 2001 to December 2008, a total of 477 consecutive adult (>18 years) patients with severe TBI were included retrospectively in the study. Patients who underwent ICP monitoring (n=52) were compared with those who did not (n=425). The primary outcome was hospital mortality. Secondary outcomes were ICU mortality, mechanical ventilation duration, the need for tracheostomy, and ICU and hospital length of stay (LOS). After adjustment for multiple potential confounding factors, ICP monitoring was not associated with significant difference in hospital or ICU mortality (odds ratio [OR]=1.71, 95% confidence interval [CI]=0.79 to 3.70, P=0.17; OR=1.01, 95% CI=0.41 to 2.45, P=0.99, respectively). ICP monitoring was associated with a significant increase in mechanical ventilation duration (coefficient=5.66, 95% CI=3.45 to 7.88, P <0.0001), need for tracheostomy (OR=2.02, 95% CI=1.02 to 4.03, P=0.04), and ICU LOS (coefficient=5.62, 95% CI=3.27 to 7.98, P <0.0001), with no significant difference in hospital LOS (coefficient=8.32, 95% CI=-82.6 to 99.25, P=0.86). Stratified by the Glasgow Coma Scale score, ICP monitoring was associated with a significant increase in hospital mortality in the group of patients with Glasgow Coma Scale 7 to 8 (adjusted OR=12.89, 95% CI=3.14 to 52.95, P=0.0004). In patients with severe TBI, ICP monitoring was not associated with reduced hospital mortality, however, with a significant increase in mechanical ventilation duration, need for tracheostomy, and ICU LOS.

scholarly journals Intracranial Pressure Monitoring in Severe Traumatic Brain Injury – Results of a Canadian Survey

2000 ◽  
Vol 27 (2) ◽  
pp. 143-147 ◽  
Author(s):  
Ramesh Sahjpaul ◽  
Murray Girotti
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Prospective Trial ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Level Of Confidence ◽  
Routine Monitoring ◽  
Severe Tbi ◽  
High Level

ABSTRACT:Objective:The purpose of this study was to obtain information from Canadian neurosurgeons regarding their opinions on, and utilization of, intracranial pressure (ICP) monitoring for severe traumatic brain injury (TBI).Methods:A brief survey was sent to practicing Canadian neurosurgeons questioning them about their utilization of, and confidence in, intracranial pressure monitoring in the management of patients with severe TBI.Results:One hundred and ninety-six surveys were mailed. There were 103 responses for a response rate of 52.6%. The vast majority of responding neurosurgeons (98.1%) utilized ICP monitoring in the management of patients with severe TBI, with most (63.4%) using it in more than 75% of their patients, 14.9% using it in 50-75% of patients, 14.9% in 25-50% of patients, and 6.9% using it in less than 25% of patients. The level of confidence that routine monitoring improves outcome from severe TBI ranged from 23.3% having a low level of confidence, 56.3% having an intermediate level of confidence, to 20.4% having a high level of confidence. Most respondents (78.6%) felt that some form of prospective trial evaluating the role of ICP monitoring in improving outcome from severe TBI was warranted; 17.4% felt such a trial was not warranted and 3.9% were uncertain.Conclusions:While ICP monitoring has gained almost universal acceptance among responding Canadian neurosurgeons, their level of confidence that routine monitoring improves outcome from severe TBI was quite variable, with only 20.4% of respondents having a high level of confidence. Over 75% of respondents felt that some form of prospective trial evaluating the utility of ICP monitoring is warranted. This information is being used in consideration of a prospective trial addressing this issue.

scholarly journals Noninvasive epicutaneous transfontanelle intracranial pressure monitoring in children under the age of 1 year: a novel technique

2016 ◽  
Vol 18 (3) ◽  
pp. 372-376 ◽  
Author(s):  
Bedjan Behmanesh ◽  
Matthias Setzer ◽  
Anika Noack ◽  
Marco Bartels ◽  
Johanna Quick-Weller ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intraventricular Hemorrhage ◽  
Standard Technique ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Novel Technique ◽  
Significant Difference ◽  
A New Technique

Monitoring of intracranial pressure (ICP) may be indicated in children with traumatic brain injury, premature intraventricular hemorrhage, or hydrocephalus. The standard technique is either a direct measurement with invasive intracranial insertion of ICP probes or indirect noninvasive assessment using transfontanelle ultrasonography to measure blood flow. The authors have developed a new technique that allows noninvasive epicutaneous transfontanelle ICP measurement with standard ICP probes. They compared the ICP measurements obtained using the same type of standard probe used in 2 different ways in 5 infants (age < 1 year) undergoing surgery for craniosynostosis. The first ICP probe was implanted epidurally (providing control measurements) and the second probe was fixed epicutaneously on the skin over the reopened frontal fontanelle. ICP values were measured hourly for the first 24 hours after surgery and the values obtained with the 2 methods were compared using Bland-Altman 2-methods analysis. A total of 110 pairs of measurements were assessed. There was no significant difference between the ICPs measured using the epicutaneous transfontanelle method (mean 13.10 mm Hg, SEM 6.68 mm Hg) and the epidural measurements (mean 12.46 mm Hg, SEM 6.45 mm Hg; p = 0.4643). The results of this analysis indicate that epicutaneous transfontanelle measurement of ICP is a reliable method that allows noninvasive ICP monitoring in children under the age of 1 year. Such noninvasive ICP monitoring could be implemented in the therapy of children with traumatic brain injury or intraventricular hemorrhage or for screening children with elevated ICP without invasive intracranial implantation of ICP probes.

scholarly journals Intracranial pressure monitoring among children with severe traumatic brain injury

2015 ◽  
Vol 16 (5) ◽  
pp. 523-532 ◽  
Author(s):  
Aziz S. Alali ◽  
David Gomez ◽  
Chethan Sathya ◽  
Randall S. Burd ◽  
Todd G. Mainprize ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Observational Study ◽  
Hospital Mortality ◽  
Pediatric Trauma ◽  
Trauma Centers ◽  
Icp Monitoring ◽  
Hospital Level ◽  
Severe Tbi

OBJECT Well-designed studies linking intracranial pressure (ICP) monitoring with improved outcomes among children with severe traumatic brain injury (TBI) are lacking. The main objective of this study was to examine the relationship between ICP monitoring in children and in-hospital mortality following severe TBI. METHODS An observational study was conducted using data derived from 153 adult or mixed (adult and pediatric) trauma centers participating in the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) and 29 pediatric trauma centers participating in the pediatric pilot TQIP between 2010 and 2012. Random-intercept multilevel modeling was used to examine the association between ICP monitoring and in-hospital mortality among children with severe TBI ≤16 years of age after adjusting for important confounders. This association was evaluated at the patient level and at the hospital level. In a sensitivity analysis, this association was reexamined in a propensity-matched cohort. RESULTS A total of 1705 children with severe TBI were included in the study cohort. The overall in-hospital mortality was 14.3% of patients (n = 243), whereas the mortality of the 273 patients (16%) who underwent invasive ICP monitoring was 11% (n = 30). After adjusting for patient- and hospital-level characteristics, ICP monitoring was associated with lower in-hospital mortality (adjusted OR 0.50; 95% CI 0.30–0.85; p = 0.01). It is possible that patients who were managed with ICP monitoring were selected because of an anticipated favorable or unfavorable outcome. To further address this potential selection bias, the analysis was repeated with the hospital-specific rate of ICP monitoring use as the exposure. The adjusted OR for death of children treated at high ICP–use hospitals was 0.49 compared with those treated at low ICP-use hospitals (95% CI 0.31–0.78; p = 0.003). Variations in ICP monitoring use accounted for 15.9% of the interhospital variation in mortality among children with severe TBI. Similar results were obtained after analyzing the data using propensity score-matching methods. CONCLUSIONS In this observational study, ICP monitoring use was associated with lower hospital mortality at both the patient and hospital levels. However, the contribution of variable ICP monitoring rates to interhospital variation in pediatric TBI mortality was modest.

scholarly journals Study of Intracranial Pressure Monitoring In Traumatic Brain Injury

2018 ◽  
Vol 15 (2) ◽  
pp. 23-29
Author(s):  
Nilam Khadka ◽  
Rajan Kumar Sharma ◽  
Rajiv Jha ◽  
Prakash Bista
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Fiber Optic ◽  
Standard Of Care ◽  
Intracranial Pressure Monitoring ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Serious Adverse Events ◽  
Monitoring Modality

Intracranial pressure monitoring is considered the standard of care for severe traumatic brain injury and is used frequently. However, the efficacy of treatment based on monitoring in improving the outcome has not been rigorously assessed. We conducted a trial in which we included 26 patients of all types of traumatic brain injury (TBI) and they were monitored for intracranial pressure by Conventional fluid filled system with a manometer (Group 1) and compared with the Fiber optic transducer-tipped intracranial pressure monitoring system (Group 2).The main aim of this study was to examine the relationship between Intracranial Pressure (ICP) monitoring and in-hospital mortality. The median length of stay in the ICU was similar in the two groups (12 days in the conventional pressure-monitoring group and 9 days in the new fiber optic group; P=0.25), the number of days of brain-specific treatments (e.g., administration of hyperosmolar fluids and the use of hyperventilation) in the ICU was similar in both groups. The distribution of serious adverse events was similar in the two groups. We concluded that ICP monitoring (as is any monitoring modality) is a useful guide for management. The outcomes are decided by the differences in management protocols that the knowledge of the said parameter brings about. ICP monitoring is recommended for the better management of traumatic brain injury and fiber optic ICP monitoring seems to be beneficial than using the conventional methods of ICP monitoring with manometer.Nepal Journal of Neuroscience, Volume 15, Number 2, 2018, page: 23-29

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

2012 ◽  
Vol 117 (4) ◽  
pp. 729-734 ◽  
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.

scholarly journals Impact of Intracranial Pressure Monitoring on Mortality in Patients with Severe Traumatic Brain Injury

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A K Ali ◽  
A E Abdelbar ◽  
A R Farghaly ◽  
M K A Uthman
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
English Literature ◽  
Intracranial Pressure Monitoring ◽  
Occurrence Rate ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Mortality And Morbidity

Abstract Background Traumatic brain injury (TBI) is among the most important public health problems associated with high healthcare and social burden and significant mortality and morbidity. Overall low income countries have the highest TBI associated mortality and morbidity. Aim of the Work Some studies have demonstrated that intracranial pressure (ICP) monitoring reduces the mortality of traumatic brain injury (TBI). But other studies have shown that ICP monitoring is associated with increased mortality. Patients and Methods Systematic review of Published English literature from 2000 to 2017. Using appropriate combinations of MeSH terms and key words, including intracranial pressure, intracranial hypertension, ICP monitor, intracranial pressure monitoring, TBI traumatic brain injury, and craniocerebral trauma. Brain Trauma Foundation guidelines, mortality. We performed this relatively wide search to include the maximum number of relevant patients. Results In total, 2552 studies were identified and screened for retrieval using the strategy described above. After careening the title and abstract, 1968 studies were excluded and 554 were retrieved and subjected to detailed evaluations. Based on the inclusion and exclusion criteria, 527 of those studies were excluded, and thus 27 studies were included in the systematic review. All included studies were published, peer-previewed papers. Conclusion ICP monitoring may play a role in decreasing the rate of electrolyte disturbances, rate of renal failure, and increasing favorable functional outcome. However, there was no significant effect for reducing the risk of hospital mortality, lowering occurrence rate of pulmonary infection, use of mechanical ventilation and duration of hospital stays. RCTs with larger sample size are necessary to further support the current results.

scholarly journals Increased S-Nitrosothiols and S-Nitrosoalbumin in Cerebrospinal Fluid after Severe Traumatic Brain Injury in Infants and Children: Indirect Association with Intracranial Pressure

2003 ◽  
Vol 23 (1) ◽  
pp. 51-61 ◽  
Author(s):  
Hülya Bayir ◽  
Patrick M. Kochanek ◽  
Shang-Xi Liu ◽  
Antonio Arroyo ◽  
Anatoly Osipov ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebrospinal Fluid ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Fold Increase ◽  
Infants And Children ◽  
No Production ◽  
Secondary Damage ◽  
Severe Tbi ◽  
Pediatric Tbi

Nitric oxide (NO) is implicated in both secondary damage and recovery after traumatic brain injury (TBI). Transfer of NO groups to cysteine sulfhydryls on proteins produces S-nitrosothiols (RSNO). S-nitrosothiols may be neuroprotective after TBI by nitrosylation of N-methyl-D-aspartate receptor and caspases. S-nitrosothiols release NO on decomposition for which endogenous reductants (i.e., ascorbate) are essential, and ascorbate is depleted in cerebrospinal fluid (CSF) after pediatric TBI. This study examined the presence and decomposition of RSNO in CSF and the association between CSF RSNO level and physiologic parameters after severe TBI. Cerebrospinal fluid samples (n = 72) were obtained from 18 infants and children on days 1 to 3 after severe TBI (Glasgow Coma Scale score < 8) and 18 controls. Cerebrospinal fluid RSNO levels assessed by fluorometric assay peaked on day 3 versus control (1.42 ± 0.11 μmol/L vs. 0.86 ± 0.04, P < 0.05). S-nitrosoalbumin levels were also higher after TBI (n = 8, 0.99 ± 0.09 μmol/L on day 3 vs. n = 6, 0.42 ± 0.02 in controls, P < 0.05). S-nitrosoalbumin decomposition was decreased after TBI. Multivariate analysis showed an inverse relation between CSF RSNO and intracranial pressure and a direct relation with barbiturate treatment. Using a novel assay, the presence of RSNO and S-nitrosoalbumin in human CSF, an ∼1.7-fold increase after TBI, and an association with low intracranial pressure are reported, supporting a possible neuroprotective role for RSNO. The increase in RSNO may result from increased NO production and/or decreased RSNO decomposition.

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