Safety and Outcome of Intracranial Pressure Monitor Placement Performed by Trauma Critical Care Surgeons

2021 ◽  
pp. 000313482110562
Author(s):  
Malka H. Fox-Epstein ◽  
Sarah S. Baker ◽  
Brian C. Thurston ◽  
Charles E. Morrow ◽  
Caleb J. Mentzer ◽  
...  
Keyword(s):  
Critical Care ◽  
Intracranial Pressure ◽  
Injury Severity ◽  
Practice Change ◽  
Control Group ◽  
Trauma Patients ◽  
Provider Type ◽  
Pressure Monitor ◽  
Computed Tomographic ◽  
Brain Trauma Foundation

Introduction The Brain Trauma Foundation advises intracranial pressure monitor placement (ICPM) following traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) score ≤8 and an abnormal head computed tomographic scan (CT) finding. Prior studies demonstrated that ICPMs could be placed by non-neurosurgeons. We hypothesized that ICPM placement by trauma critical care surgeons (TCCS) would increase appropriate utilization (AU), decrease time to placement (TTP), and have equivalent complications to those placed by neurosurgeons. Methods We retrospectively reviewed medical records of adult trauma patients admitted with a TBI in a historical control group (HCG) and practice change group (PCG). Demographics, Injury Severity Score (ISS), outcomes, ICPM placement by provider type, and time to placement were identified. Complications and appropriate utilization were recorded. Results 70 patients in the HCG and 84 patients in the PCG met criteria for inclusion. Demographics, arrival GCS, ICU GCS, ISS, and admission APACHE II scores were not statistically significant. AU was 7/70 for HCG vs 19/84 in the PCG ( P = .04036). Median TTP was 6.5 hours for HCG vs 5.25 for PCG ( P = .9308). Interquartile range showed the data clustered around an earlier placement time, 2.3-14.0 hours, in the PCG. Complications between the 2 groups were not statistically significant, 0/7 for HCG vs 5/19 for PCG ( P = .2782). Discussion This study confirms that ICPMs can be safely placed by TCCS. Our results demonstrate that placement of ICPMs by TCCS improves AU and possibly improves TTP.

Decreased Intracranial Pressure Monitor Use at Level II Trauma Centers is Associated with Increased Mortality

2012 ◽  
Vol 78 (10) ◽  
pp. 1166-1171 ◽  
Author(s):  
Galinos Barmparas ◽  
Matthew Singer ◽  
Eric Ley ◽  
Rex Chung ◽  
Darren Malinoski ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Trauma Center ◽  
Injury Severity ◽  
Regression Modeling ◽  
Trauma Centers ◽  
Icp Monitoring ◽  
Pressure Monitor ◽  
Brain Trauma Foundation ◽  
Level Ii ◽  
Level I

Previous investigations suggest outcome differences at Level I and Level II trauma centers. We examined use of intracranial pressure (ICP) monitors at Level I and Level II trauma centers after traumatic brain injury (TBI) and its effect on mortality. The 2007 to 2008 National Trauma Databank was reviewed for patients with an indication for ICP monitoring based on Brain Trauma Foundation (BTF) guidelines. Demographic and clinical outcomes at Level I and Level II centers were compared by regression modeling. Overall, 15,921 patients met inclusion criteria; 11,017 were admitted to a Level I and 4,904 to a Level II trauma center. Patients with TBI admitted to a Level II trauma center had a lower rate of Injury Severity Score greater than 16 (80 vs 82%, P < 0.01) and lower frequency of head Abbreviated Injury Score greater than 3 (80 vs 82%, P < 0.01). After regression modeling, patients with TBI admitted to a Level II trauma center were 31 per cent less likely to receive an ICP monitor (adjusted odds ratio [AOR], 0.69; P < 0.01) and had a significantly higher mortality (AOR, 1.12; P < 0.01). Admission to a Level II trauma center after severe TBI is associated with a decreased use of ICP monitoring in patients who meet BTF criteria as well as an increased mortality. These differences should be validated prospectively to narrow these discrepancies in care and outcomes between Level I and Level II centers.

Decreased risk of acute kidney injury with intracranial pressure monitoring in patients with moderate or severe brain injury

2013 ◽  
Vol 119 (5) ◽  
pp. 1228-1232 ◽  
Author(s):  
Jingsong Zeng ◽  
Wusong Tong ◽  
Ping Zheng
Keyword(s):  
Acute Kidney Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Cystatin C ◽  
Kidney Injury ◽  
Control Group ◽  
Icp Monitoring ◽  
Blood Concentrations ◽  
Brain Trauma Foundation ◽  
Monitoring Group

Object The authors undertook this study to evaluate the effects of continuous intracranial pressure (ICP) monitoring–directed mannitol treatment on kidney function in patients with moderate or severe traumatic brain injury (TBI). Methods One hundred sixty-eight patients with TBI were prospectively assigned to an ICP monitoring group or a conventional treatment control group based on the Brain Trauma Foundation guidelines. Clinical data included the dynamic changes of patients' blood concentrations of cystatin C, creatinine (Cr), and blood urea nitrogen (BUN); mannitol use; and 6-month Glasgow Outcome Scale (GOS) scores. Results There were no statistically significant differences with respect to hospitalized injury, age, or sex distribution between the 2 groups. The incidence of acute kidney injury (AKI) was higher in the control group than in the ICP monitoring group (p < 0.05). The mean mannitol dosage in the ICP monitoring group (443 ± 133 g) was significantly lower than in the control group (820 ± 412 g) (p < 0.01), and the period of mannitol use in the ICP monitoring group (3 ± 3.8 days) was significantly shorter than in the control group (7 ± 2.3 days) (p < 0.01). The 6-month GOS scores in the ICP monitoring group were significantly better than in the control group (p < 0.05). On the 7th, 14th, and 21st days after injury, the plasma cystatin C and Cr concentrations in the ICP-monitoring group were significantly higher than the control group (p < 0.05). Conclusions In patients with moderate and severe TBI, ICP-directed mannitol treatment demonstrated a beneficial effect on reducing the incidence of AKI compared with treatment directed by neurological signs and physiological indicators.

A Trauma Transfusion Pathway Decreases Coagulopathy without Increasing Blood Product Utilization

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4071-4071
Author(s):  
Leonard A. Minuk ◽  
Kathleen Eckert ◽  
Tanya Charyk Stewart ◽  
Neil Parry ◽  
Daryl Gray ◽  
...  
Keyword(s):  
Injury Severity ◽  
Blood Product ◽  
Massive Transfusion ◽  
Fixed Ratio ◽  
Trauma Team ◽  
Control Group ◽  
P Value ◽  
Trauma Patients ◽  
Severe Traumatic Injury ◽  
Mean Time

Abstract Background: Trauma patients often require massive transfusion and their resuscitation is commonly complicated by coagulopathy. Debate persists regarding optimal massive transfusion strategies, which have traditionally adopted 2 approaches: coagulation laboratory based therapy (LBT) versus fixed ratio trauma transfusion pathways (TTP). The proponents of a LBT strategy cite “rational use” and avoidance of over-transfusion. This system may not adequately address the dynamic trauma situation where a delay in coagulation results may be detrimental. A TTP more rapidly meets the needs of trauma patients but may increase blood product utilization. Objective: Retrospectively compare our preliminary early experience with a TTP compared to our previous LBT strategy. Method: Retrospective cohort study using our transfusion database comparing 14 patients who activated the TTP with 28 patients treated before the pathways introduction. Inclusion criteria included severe traumatic injury (Injury Severity Score (ISS) &gt;12), massive transfusion (defined as &gt;8 units of red blood cells (RBCs) in the first 24 hours). The TTP is activated by the trauma team and results in the immediate release of 4 units of uncrossmatched RBCs. Blood product is then issued in trauma packs (TPs). Each trauma pack contains 4 units of RBCs and 4 units of frozen plasma (FP) and every second pack contains one pool of platelets (PLTs). A dose of recombinant factor VIIa (rFVIIa) is made available after TP #3. Cryoprecipitate (CRYO) is issued only at the request of the trauma team. A CBC, INR, PTT, and fibrinogen is measured at TTP activation and after every other TP. Outcomes: Outcome variables included total blood product utilization (RBC, FP, CRYO, PLTs), time to first and second set of FP (time 0 is release of 1st RBC unit), number of RBC units issued until first and second set of FP, coagulopathy at presentation and highest INR during first 24 hours of resuscitation. Results: The results are summarized in the attached table. There was no difference in ISS between groups. The introduction of the TTP resulted in no difference in the amount of blood product utilization when compared to the pre-pathway control group. Significant differences included a much shorter time to first and second FP delivery and fewer RBC units before the first and second FP delivery. The majority of the patients were coagulopathic on presentation (defined as INR &gt; 1.4) and the TTP group achieved a significantly lower peak INR during the first 24 hours of resuscitation compared to the pre-pathway group. Conclusion: This pilot study shows that the introduction of a trauma transfusion pathway significantly improves coagulopathy and reduces time to FP administration without increasing blood product utilization. Pre-Pathway (n=28) Trauma Transfusion Pathway (n=14) P-value Mean ISS 42.0 ± 12.5 34 ± 15.1 NS Mean RBC units used 23.4 ± 14.5 23.1 ± 10.7 NS Mean FP units used 13.4 ± 9.6 16.1 ± 8.3 NS Mean PLT pools used 1.8 ± 1.5 2.7 ± 1.8 NS Mean CRYO pools used 0.46 ± 0.64 0.71 ± 0.83 NS Mean time to 1stFP (min) 89.9 ± 55.5 55.4 ± 49.2 0.02 Mean time to 2ndFP (min) 237.0 ± 206.8 103.0 ± 59.4 0.0004 Mean #RBC units to 1st set FP 10.4 ± 9.0 7.8 ± 1.6 0.02 Mean #RBC units to 2nd set FP 17.6 ± 8.8 12.9 ± 3.4 0.016 # Patients coagulopathic on initial testing (INR&gt;1.4) 12 (43%) 8 (62%) NS Mean initial INR 1.5 ± 0.55 1.7 ± 0.58 NS Mean of highest INR in first 24h 2.3 ± 1.70 1.4 ± 0.25 0.006 # Patients given rFVIIa 6 (21%) 5 (36%) NS

scholarly journals Prehospital critical care is associated with increased survival in adult trauma patients in Scotland

2020 ◽  
Vol 37 (3) ◽  
pp. 141-145 ◽  
Author(s):  
Alistair Maddock ◽  
Alasdair R Corfield ◽  
Michael J Donald ◽  
Richard M Lyon ◽  
Neil Sinclair ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Critical Care ◽  
Major Trauma ◽  
Injury Severity ◽  
Prehospital Care ◽  
National Registry ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Data Set ◽  
Major Trauma Centre

BackgroundScotland has three prehospital critical care teams (PHCCTs) providing enhanced care support to a usually paramedic-delivered ambulance service. The effect of the PHCCTs on patient survival following trauma in Scotland is not currently known nationally.MethodsNational registry-based retrospective cohort study using 2011–2016 data from the Scottish Trauma Audit Group. 30-day mortality was compared between groups after multivariate analysis to account for confounding variables.ResultsOur data set comprised 17 157 patients, with a mean age of 54.7 years and 8206 (57.5%) of male gender. 2877 patients in the registry were excluded due to incomplete data on their level of prehospital care, leaving an eligible group of 14 280. 13 504 injured adults who received care from ambulance clinicians (paramedics or technicians) were compared with 776 whose care included input from a PHCCT. The median Injury Severity Score (ISS) across all eligible patients was 9; 3076 patients (21.5%) met the ISS>15 criterion for major trauma. Patients in the PHCCT cohort were statistically significantly (all p<0.01) more likely to be male; be transported to a prospective Major Trauma Centre; have suffered major trauma; have suffered a severe head injury; be transported by air and be intubated prior to arrival in hospital. Following multivariate analysis, the OR for 30-day mortality for patients seen by a PHCCT was 0.56 (95% CI 0.36 to 0.86, p=0.01).ConclusionPrehospital care provided by a physician-led critical care team was associated with an increased chance of survival at 30 days when compared with care provided by ambulance clinicians.

Identification of Sarcopenia in Elderly Trauma Patients: The Value of Clinical Competency and Experience

2021 ◽  
pp. 000313482098285
Author(s):  
Daisy M. Proksch ◽  
Katherine M. Kelley ◽  
Sasha White ◽  
Jessica R. Burgess
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Functional Status ◽  
Injury Severity ◽  
Psoas Muscle ◽  
Control Group ◽  
Trauma Patients ◽  
Medical Providers ◽  
Phone Calls ◽  
Elderly Trauma Patients

Introduction There is currently no standard definition of sarcopenia, which has often been associated with frailty. A commonly cited surrogate measure of sarcopenia is psoas muscle size. The purpose of this prospective study is to assess medical providers’ capabilities to identify frail elderly trauma patients and consequent impact on outcomes after intensive care unit admission. Methods Trauma intensive care unit patients over the age of 50 were enrolled. A preadmission functional status questionnaire was completed on admission. Attendings, residents, and nurses, blinded to their patient’s sarcopenic status, completed surveys regarding 6-month prognosis. Chart review included cross-sectional psoas area measurements on computerized tomography scan. Finally, patients received phone calls 3 and 6 months after admission to determine overall health and functional status. Results Seventy-six participants had an average age of 70 years and a corrected psoas area of 383 ± 101 mm2/m2. Injury Severity Score distribution (17.2 ± 8.9) was similar for both groups. Patients also had similar preinjury activities of daily living. Both groups had similar hospital courses. While sarcopenic patients were less likely to be predicted to survive to 6 months (60% vs. 76%, P = 0.017), their actual 6-month mortality was similar (22% vs. 21%, P = 0.915). Conclusion Despite similar objective measures of preadmission health and trauma injury severity, medical providers were able to recognize frail patients and predicted they would have worse outcomes. Interestingly, sarcopenic patients had similar outcomes to the control group. Additional studies are needed to further delineate factors influencing provider insight into functional reserves of elderly trauma patients.

scholarly journals The results of a multicenter retrospective controlled clinical study of the efficacy and safety of L-lysine aescinate® in the treatment of traumatic and postoperative cerebral edema

2021 ◽  
Vol 16 (8) ◽  
pp. 21-32
Author(s):  
Yu.Yu. Kobeliatskyi ◽  
I.S. Bobryk ◽  
A.M. Netliukh ◽  
I.I. Ilashchuk ◽  
D.S. Ivakhnenko
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intracranial Pressure ◽  
Cerebral Edema ◽  
Standard Therapy ◽  
Injury Severity ◽  
Control Group ◽  
Combination Drug ◽  
Brain Functions ◽  
Significant Difference

In modern guidelines, the control of intracranial pressure is recognized as an important prerequisite for quality reco-very of brain functions after severe traumatic brain injury (TBI). Among the relatively new approaches to the control of intracranial pressure in severe TBI, a combination drug L-lysine aescinate® is considered. It has endotheliotropic, venotonic, anti-inflammatory, antiplatelet and other effects that allow it to be regarded as a mean for preventing and reducing cerebral edema after TBI. To evaluate the efficacy and effects of L-lysine aescinate®, a multicenter retrospective study was conducted that included 988 patients aged 18 to 65 years with isolated or combined severe or moderate TBI. The median injury severity index was 17 points, i.e. most people had a serious injury. Patients were randomized into two groups, one of which (n = 335) received only standard therapy, while the other (n = 653) — additionally L-lysine aescinate®. L-lysine aescinate® was prescribed on the first day of hospitalization (median — 2.75 hours) and for a course of 2 to 8 days (median — 7 days). Mortality in the intensive care unit (primary endpoint) was 10.3 and 24.2 % in the main and control groups, respectively (difference 13.9 %; 95% confidence interval (CI): 8.93–19.21 %; p < 0.001). Logistic regression method revealed that L-lysine aescinate® was the most important factor influencing patient survival (p < 0.001). Its use increased the chances of survival of a patient with TBI in the intensive care unit by 3.3 times (odds ratio (OR) = 3.311; 95% CI: 2.108–5.200). Similar results were obtained for 30-day hospital mortality. The frequency of recovery of clear consciousness during the hospital stay was 87.0 % in the group of L-lysine aescinate® and 66.0 % in the control group, with a significant difference between them (p < 0.001). Administration of L-lysine aescinate® increased the chances for restoring clear consciousness in a patient with TBI by 3.8 times (OR = 3.823; 95% CI: 2.535–5.765). The results of the study allow us to recommend the inclusion of L-lysine aescinate® in the standard therapy of patients with isolated or combined severe or moderate TBI.

scholarly journals Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach

2018 ◽  
Vol 3 (1) ◽  
pp. e000228 ◽  
Author(s):  
Joost D J Plate ◽  
Linda M Peelen ◽  
Luke P H Leenen ◽  
Falco Hietbrink
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Trauma Patient ◽  
Injury Severity ◽  
Cost Savings ◽  
Fixed Cost ◽  
Trauma Patients ◽  
Intermediate Care ◽  
Intermediate Care Unit ◽  
Icu Transfer

BackgroundThe aim of this study was to describe the case load, safety, and cost savings of critical care of the trauma patient provided at the surgical intermediate care unit (IMCU).MethodsThis cohort study included all trauma admissions between January 1, 2011 and January 7, 2015 at the general intensive care unit (ICU), stand-alone neuro(surgical) IMCU, and stand-alone (trauma) surgical IMCU. Trauma mechanism, Abbreviated Injury Scale score and Injury Severity Score (ISS), vital signs, laboratory parameters, admission duration, intubation duration, ICU transfer, and in-hospital mortality were prospectively collected. Hypothetical cost savings were calculated using the fixed cost price per IMCU (US$1500) and ICU (US$2500) admission day.ResultsA total of 1320 admissions were included, 675 (51.1%) at the IMCU and 645 (48.9%) at the ICU. Patients admitted at the IMCU had a median ISS of 17 (11, 22). Their median duration of admission was 32.8 hours (18.8, 62.5). At the IMCU, one patient died due to aneurogenic shock. A subsequent ICU transfer was required in 38 (5.6%) IMCU admissions. Of these transfers, four patients died due to neurological deterioration. At the ICU, the median ISS was 22 (14, 30). Nearly all (n=620, 96.3%) ICU trauma patients required mechanical ventilation. Expected total cost savings due to the presence of the IMCU were US$1 772 785.DiscussionA substantial amount of trauma patients in need of critical care can safely be admitted at the IMCU, without the need for further mechanical ventilation. Thereby, the IMCU could fulfill an essential cost-saving role in the management of severely injured trauma patients.Level of evidenceLevel IV.

scholarly journals Respect your elders: effects of ageing on intracranial pressure monitor use in traumatic brain injury

2019 ◽  
Vol 4 (1) ◽  
pp. e000306 ◽  
Author(s):  
Alexander J Schupper ◽  
Allison E Berndtson ◽  
Alan Smith ◽  
Laura Godat ◽  
Todd W Costantini
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Injury Severity ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
Brain Trauma ◽  
Hospital Length Of Stay ◽  
Level Of Evidence ◽  
Brain Trauma Foundation

BackgroundThe Brain Trauma Foundation recommends intracranial pressure (ICP) monitor placement for patients with severe traumatic brain injury (TBI). Adherence with these guidelines in elderly patients is unknown. We hypothesized that disparities in ICP monitor placement would exist based on patient age.MethodsUsing the National Trauma Data Bank (2010–2014), we identified patients admitted for blunt TBI with admission Glasgow Coma Scale (GCS) scores of 3–8. Patients were excluded if they had a non-Head Abbreviated Injury Scale (AIS) score ≥3, hospital length of stay <24 hours or were discharged from the emergency department. Demographic data, ICP monitor placement, GCS, AIS-Head, Injury Severity Score, and outcome measures were collected. Propensity score matching between ICP monitor and non-ICP monitor patients was used for logistic regression and Cox multivariate regression analyses.ResultsOf the 30 710 patients with blunt TBI with GCS scores of 3–8 included in our study, 4093 were treated with an ICP monitor. ICP monitor placement rates significantly decreased with increasing age. Multivariable analysis demonstrated that patients treated with an ICP monitor were more likely to be younger, male, have private/commercial insurance, and receive care at an institution with three or more neurosurgeons.ConclusionPatients ≥65 years of age with severe blunt TBI are less likely to be treated with an ICP monitor than younger patients. Age disparities in adherence to Brain Trauma Foundation guidelines may alter the outcomes for patients with severe TBI.Level of evidenceLevel IV.

scholarly journals Prognostic significance of intracranial pressure monitoring and intracranial hypertension in severe brain trauma patients

2011 ◽  
Vol 64 (9-10) ◽  
pp. 461-465 ◽  
Author(s):  
Aleksandar Kostic ◽  
Ivan Stefanovic ◽  
Vesna Novak ◽  
Dragan Veselinovic ◽  
Goran Ivanov ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Prognostic Significance ◽  
Brain Trauma ◽  
Intracranial Pressure Monitoring ◽  
Control Group ◽  
Trauma Patients ◽  
Pressure Monitoring ◽  
Prognostic Effect ◽  
Significant Difference

Since without prospective randomized studies it is not possible to have a clear attitude towards the importance of intracranial pressure monitoring, this study was aimed at examining the prognostic effect of the intracranial pressure monitoring and intracranial pressure oriented therapy in severe brain trauma patients, and at defining optimal intracranial pressure values for starting the treatment. Two groups of patients were treated in the study, one consisted of 32 patients undergoing intracranial pressure monitoring and the second group of 29 patients without intracranial pressure monitoring in the control group. The study was prospective with groups randomized. There were 53% survivals in the intracranial pressure monitored patients and 34% in the control group, with no significant difference in the survival rate between the two groups (?2=2.11; p=0.15; p>0.05). The average intracranial pressure in the patients with intracranial hypertension who died was 27 mm Hg, while in the patients who survived the average intracranial pressure was significantly lower (Student?s t test: t=2.91; p=0.008; p<0.01) and it was 18 mm Hg. We recommend starting intracranial pressure oriented therapy when the patient?s intracranial pressure exceeds 18 mmHg during 2 hours of monitoring.

Inaccurate Pressure Readings for Subarachnoid Bolts

Neurosurgery ◽  
1986 ◽  
Vol 19 (2) ◽  
pp. 253-255 ◽  
Author(s):  
Jimmy D. Miller ◽  
Hunt Bobo ◽  
John P. Kapp
Keyword(s):  
Cardiac Arrest ◽  
Intracranial Pressure ◽  
Epidural Hematoma ◽  
Seizure Activity ◽  
The Other ◽  
Wave Form ◽  
Reye's Syndrome ◽  
Pressure Monitor ◽  
Computed Tomographic ◽  
Increased Pressure

Abstract The subarachnoid bolt has been used extensively to monitor intracranial pressure in a variety of conditions. We have had two patients who had subarachnoid bolts in place that were thought to be functional in whom evidence of increased pressure was present. In one case, the patient had Reye's syndrome with seizure activity, decerebrate posturing, fixed and dilated pupils, and cardiac arrest. Although autopsy revealed evidence of cerebellar and uncal herniation, verifying the presence of pressure cones, the subarachnoid bolt pressure was never elevated and had a good wave form. In the other case, the patient developed an epidural hematoma postoperatively while a subarachnoid bolt was in place. The subarachnoid bolt was measuring pressures of less than 15 mm Hg with a good wave form despite clinical and, subsequently, computed tomographic evidence of an evolving mass. The use of a pressure monitor such as the subarachnoid bolt should not replace frequent clinical assessment of the patient.

Sign in / Sign up

Export Citation Format

Share Document