Novel models to predict elevated intracranial pressure during intensive care and long-term neurological outcome after TBI

Object The management strategies and outcomes in pediatric patients with elevated intracranial pressure (ICP) following severe traumatic brain injury (TBI) are examined in this study. Methods This study was a retrospective review of a prospectively acquired pediatric trauma database. More than 750 pediatric patients with brain injury were seen over a 10-year period. Records were retrospectively reviewed to determine interventions for correcting ICP, and surviving patients were contacted prospectively to determine functional status and quality of life. Only patients with 2 years of follow-up were included in the study. Results Ninety-six pediatric patients (age range 3–18 years) were identified with a Glasgow Coma Scale score < 8 and elevated ICP > 20 mm Hg on presentation. The mean injury severity score was 65 (range 30–100). All patients were treated using a standardized head injury protocol. The mean time course until peak ICP was 69 hours postinjury (range 2–196 hours). Intracranial pressure control was achieved in 82 patients (85%). Methods employed to achieve ICP control included maximal medical therapy (sedation, hyperosmolar therapy, and paralysis) in 34 patients (35%), ventriculostomy in 23 patients (24%), and surgery in 39 patients (41%). Fourteen patients (15%) had refractory ICP despite all interventions, and all of these patients died. Seventy-two patients (75%) were discharged from the hospital, whereas 24 (25%) died during hospitalization. Univariate and multivariate analysis revealed that the presence of vascular injury, refractory ICP, and cisternal effacement at presentation had the highest correlation with subsequent death (p < 0.05). Mean follow-up was 53 months (range 11–126 months). Three patients died during the follow-up period (2 due to infections and 1 committed suicide). The mean 2-year Glasgow Outcome Scale score was 4 (median 4, range 1–5). The mean patient competency rating at follow-up was 4.13 out of 5 (median 4.5, range 1–4.8). Univariate analysis revealed that the extent of intracranial and systemic injuries had the highest correlation with long-term quality of life (p < 0.05). Conclusions Controlling elevated ICP is an important factor in patient survival following severe pediatric TBI. The modality used for ICP control appears to be less important. Long-term follow-up is essential to determine neurocognitive sequelae associated with TBI.

Download Full-text

Elimination of methohexitone after long-term, high-dose infusion in patients with critically elevated intracranial pressure

Critical Care Medicine ◽

10.1097/00003246-199908000-00028 ◽

1999 ◽

Vol 27 (8) ◽

pp. 1570-1576 ◽

Cited By ~ 11

Author(s):

Joachim Schickendantz ◽

Wolfgang Funk ◽

Karl-Peter Ittner ◽

Michael Gruber ◽

Kai Taeger ◽

...

Keyword(s):

Intracranial Pressure ◽

High Dose ◽

Elevated Intracranial Pressure ◽

Dose Infusion

Download Full-text

Intracranial and Blood Pressure Variability and Long-Term Outcome After Aneurysmal Sub-arachnoid Hemorrhage

American Journal of Critical Care ◽

10.4037/ajcc2009743 ◽

2009 ◽

Vol 18 (3) ◽

pp. 241-251 ◽

Cited By ~ 10

Author(s):

Catherine J. Kirkness ◽

Robert L. Burr ◽

Pamela H. Mitchell

Keyword(s):

Blood Pressure ◽

Intensive Care ◽

Subarachnoid Hemorrhage ◽

Intracranial Pressure ◽

Functional Outcome ◽

Adaptive Capacity ◽

Arterial Blood Pressure ◽

Long Term Outcome ◽

Arterial Blood

Background Care of brain-injured patients in intensive care units has focused on maintaining arterial blood pressure and intracranial pressure within prescribed ranges. Research suggests, however, that the dynamic variability of these pressure signals provides additional information about physiological functioning and may reflect adaptive capacity.Objectives To see if long-term outcomes can be predicted from variability of arterial blood pressure and intracranial pressure in patients with aneurysmal subarachnoid hemorrhage.Methods Arterial blood pressure and intracranial pressure were monitored continuously for 4 days in 90 patients (74% women; mean age, 53 years) in an intensive care unit after subarachnoid hemorrhage. Variability of arterial blood pressure and intracranial pressure signals was calculated on 4 timescales: 24 hours, 1 hour, 5 minutes, and the difference of sequential 5-second means. The Extended Glasgow Outcome Scale was used to assess functional outcome 6 months after subarachnoid hemorrhage.Results Pressure variability was better than mean pressure levels for predicting 6-month functional outcome. When initial neurological condition was controlled for, greater faster variability (particularly 5-second) was associated with better outcomes (typical P<.001), whereas greater 24-hour variability was associated with poorer outcomes (typical P<.001).Conclusions The relationship between long-term functional outcome and variability of arterial blood pressure and intracranial pressure levels depends on the timescale at which the variability is measured. Because it is associated with better outcome, greater faster variability may reflect better physiological adaptive capacity.

Download Full-text

Intracranial hypertension and empty Sella from adrenal adenoma and excessive and prolonged steroid usage: a case report

BMC Endocrine Disorders ◽

10.1186/s12902-021-00931-2 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Naiqian Zhao ◽

Weixia Yang ◽

Xiaoyan Li ◽

Li Wang ◽

Ying Feng

Keyword(s):

Case Report ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Low Dose ◽

Adrenal Adenoma ◽

Empty Sella ◽

Elevated Intracranial Pressure ◽

Cerebrospinal Fluid Rhinorrhea ◽

Free Cortisol

Abstract Background There is only one documented case of intracranial hypertension (IH) and empty sella from cortisol-producing adrenal adenoma so far. And IH and empty sella caused by long-term exogenous hypercortisolism has never been reported before. The purpose of this case report is to alert clinicians to glucocorticoid-induced IH. Case presentation We present retrospectively a 50-year-old woman with cortisol-secreting adrenal adenoma, who progressed to intractable intracranial hypertension and a markedly expanded empty sella due to improper treatment. In 2011, the patient presented with hypertension, lack of cortisol circadian rhythm, low ACTH, a left adrenal adenoma and a partial empty sella, but did not receive low-dose dexamethasone suppression test (LDDST) and 24-h urinary cortisol. In 2014, she exhibited truncal obesity, raised cortisol, LDDST non-suppression, high urinary free cortisol and low ACTH, proving her cortisol-producing adrenal adenoma. She was simultaneously diagnosed with unexplained IH because of papilledema and elevated intracranial pressure, and her partial empty sella changed to a complete empty sella. In 2015, she underwent adrenal adenoma resection. From 2015 to 2018, she kept taking dexamethasone at least 2 mg daily without her doctors’ consent. During this period, she developed transient cerebrospinal fluid rhinorrhea, and her empty sella further worsened. After switching to low dose hydrocortisone, her papilledema disappeared completely, but optic atrophy has become irreversible. Conclusions The patient seems to be just an extreme case, but it may reveal and illustrate a general phenomenon: Both cortisol-producing adrenal adenoma and long-term exogenous hypercortisolism could cause varying degrees of elevated intracranial pressure and empty sella. Clinicians should remain vigilant for this phenomenon in patients with cortisol-producing adrenal adenoma or excessive and prolonged steroid usage and give them corresponding examinations to identify this complication.

Download Full-text

Intensive Care Treatment Options of Elevated Intracranial Pressure Following Severe Traumatic Brain Injury

Head, Thoracic, Abdominal, and Vascular Injuries ◽

10.1007/978-3-540-88122-3_2 ◽

2010 ◽

pp. 93-152 ◽

Cited By ~ 3

Author(s):

John F. Stover ◽

Reto Stocker

Keyword(s):

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

Intracranial Pressure ◽

Severe Traumatic Brain Injury ◽

Treatment Options ◽

Intensive Care Treatment ◽

Elevated Intracranial Pressure ◽

Care Treatment

Download Full-text

Fructose-added glycerol (Glyceol®) for therapy of elevated intracranial pressure: analysis of the side effects of long-term administration in a multi-institutional trial

Neurological Research ◽

10.1080/01616412.1989.11739901 ◽

1989 ◽

Vol 11 (4) ◽

pp. 249-251 ◽

Cited By ~ 12

Author(s):

Takashi Tsubokawa ◽

Yoichi Katayama ◽

Shozo Ishii

Keyword(s):

Side Effects ◽

Intracranial Pressure ◽

Elevated Intracranial Pressure ◽

Term Administration ◽

Pressure Analysis

Download Full-text

Novel Methods to Predict Increased Intracranial Pressure During Intensive Care and Long-Term Neurologic Outcome After Traumatic Brain Injury

Critical Care Medicine ◽

10.1097/ccm.0b013e3182742d0a ◽

2013 ◽

Vol 41 (2) ◽

pp. 554-564 ◽

Cited By ~ 46

Author(s):

Fabian Güiza ◽

Bart Depreitere ◽

Ian Piper ◽

Greet Van den Berghe ◽

Geert Meyfroidt

Keyword(s):

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

Intracranial Pressure ◽

Neurologic Outcome ◽

Increased Intracranial Pressure ◽

Novel Methods

Download Full-text

Endotracheal Intubation Procedures

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0115 ◽

2019 ◽

pp. 840-845

Author(s):

Matthew J. Ritter

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Intracranial Pressure ◽

Endotracheal Intubation ◽

Elevated Intracranial Pressure ◽

Hypercapnic Respiratory Failure ◽

High Incidence

Endotracheal intubation (ETI) is one of the most common procedures performed in the intensive care unit (ICU). It is also associated with a high incidence of complications. Indications for ETI include acute hypoxemic or hypercapnic respiratory failure, loss of protective reflexes, and inability to manage secretions. Additionally, in the neurosciences ICU, intubation may be necessary for transient hyperventilation in patients with elevated intracranial pressure.

Download Full-text