Intracranial pressure monitoring in severe blunt head trauma: does the type of monitoring device matter?

2018 ◽  
Vol 128 (3) ◽  
pp. 828-833 ◽  
Author(s):  
Alberto Aiolfi ◽  
Desmond Khor ◽  
Jayun Cho ◽  
Elizabeth Benjamin ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Functional Outcome ◽  
Head Trauma ◽  
Stepwise Logistic Regression ◽  
Monitoring Device ◽  
Icp Monitoring ◽  
Improvement Program ◽  
Systemic Complications ◽  
Blunt Head Trauma

OBJECTIVEIntracranial pressure (ICP) monitoring has become the standard of care in the management of severe head trauma. Intraventricular devices (IVDs) and intraparenchymal devices (IPDs) are the 2 most commonly used techniques for ICP monitoring. Despite the widespread use of these devices, very few studies have investigated the effect of device type on outcomes. The purpose of the present study was to compare outcomes between 2 types of ICP monitoring devices in patients with isolated severe blunt head trauma.METHODSThis retrospective observational study was based on the American College of Surgeons Trauma Quality Improvement Program database, which was searched for all patients with isolated severe blunt head injury who had an ICP monitor placed in the 2-year period from 2013 to 2014. Extracted variables included demographics, comorbidities, mechanisms of injury, head injury specifics (epidural, subdural, subarachnoid, intracranial hemorrhage, and diffuse axonal injury), Abbreviated Injury Scale (AIS) score for each body area, Injury Severity Score (ISS), vital signs in the emergency department, and craniectomy. Outcomes included 30-day mortality, complications, number of ventilation days, intensive care unit and hospital lengths of stay, and functional independence.RESULTSDuring the study period, 105,721 patients had isolated severe traumatic brain injury (head AIS score ≥ 3). Overall, an ICP monitoring device was placed in 2562 patients (2.4%): 1358 (53%) had an IVD and 1204 (47%) had an IPD. The severity of the head AIS score did not affect the type of ICP monitoring selected. There was no difference in the median ISS; ISS > 15; head AIS Score 3, 4, or 5; or the need for craniectomy between the 2 device groups. Unadjusted 30-day mortality was significantly higher in the group with IVDs (29% vs 25.5%, p = 0.046); however, stepwise logistic regression analysis showed that the type of ICP monitoring was not an independent risk factor for death, complications, or functional outcome at discharge.CONCLUSIONSThis study demonstrated that compliance with the Brain Trauma Foundation guidelines for ICP monitoring is poor. In isolated severe blunt head injuries, the type of ICP monitoring device does not have any effect on survival, systemic complications, or functional outcome.

Outcomes of Blunt Head Trauma without Intracranial Pressure Monitoring

2007 ◽  
Vol 73 (5) ◽  
pp. 447-450 ◽  
Author(s):  
Gabriel Akopian ◽  
Donald J. Gaspard ◽  
Magdi Alexander
Keyword(s):  
Intracranial Pressure ◽  
Injury Severity Score ◽  
Head Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Case Series ◽  
Stepwise Logistic Regression ◽  
Icp Monitoring ◽  
Brain Trauma Foundation ◽  
Blunt Head Trauma

Although guidelines exist for intracranial pressure (ICP)-guided treatment after head trauma, no conclusive data exist that support routine ICP monitoring. A retrospective case series was reviewed of all patients admitted to the intensive care unit with a diagnosis of blunt head trauma between January 1, 1999 and December 31, 2004. None of the patients in the final analysis had ICP monitoring. Data collected included age, sex, mechanism of injury, Glasgow Coma Score (GCS) at admission, injury severity score, disposition, and length of stay. One hundred thirty-one patients with a median age of 41 years were included. There were 104 men (79%). The median GCS at admission was 12. There were 22 deaths (17% mortality). Stepwise logistic regression analysis identified older age, higher injury severity score, and lower GCS to be predictors of death. The mortality rate was higher in patients with GCS ≤8 compared with GCS >8 (33% vs 8%, respectively; P < 0.001). Ten of 23 patients with a GCS of 3 died (43% mortality). The median time to death for patients with a GCS of 3 was 2 days. Although the Brain Trauma Foundation has published guidelines advocating routine ICP monitoring, no large randomized prospective studies are available to determine its effect on outcome. None of the patients in this study had ICP monitoring. Our overall survival rate of 83 per cent is relatively high. Patients with a low GCS and, specifically, those with a GCS of 3 may not benefit from ICP monitoring because of early and irreversible trauma. Variability in the use of ICP monitoring will remain until ICP monitoring can be conclusively proven to improve outcome.

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.

Computed Tomographic Brain Density Measurement as a Predictor of Elevated Intracranial Pressure in Blunt Head Trauma

2007 ◽  
Vol 73 (10) ◽  
pp. 1023-1026 ◽  
Author(s):  
Kenji Inaba ◽  
Pedro G.R. Teixeira ◽  
Jean-Stephane David ◽  
Carlos Brown ◽  
Ali Salim ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Injury Severity ◽  
Density Measurement ◽  
Elevated Intracranial Pressure ◽  
Icp Monitoring ◽  
Brain Ct ◽  
Blunt Head Trauma ◽  
Brain Density

There are no independent computed tomography (CT) findings predictive of elevated intracranial pressure (ICP). The purpose of this study was to evaluate brain density measurement on CT as a predictor of elevated ICP or decreased cerebral perfusion pressure (CPP). A prospectively collected database of patients with acute traumatic brain injury was used to identify patients who had a brain CT followed within 2 hours by ICP measurement. Blinded reviewers measured mean density in Hounsfield Units (HU) within a 100-mm2 elliptical region at four standardized positions. Brain density measurement was compared for patients with an ICP of 20 or greater versus less than 20 mm Hg and CPP of 70 or greater versus less than 70 mm Hg. During a 2-year period, 47 patients had ICP monitoring after brain CT. Average age was 40 ± 18 years old; 93.6 per cent were male; mean Injury Severity Score was 25 ± 10; and Glasgow Coma Scale was 6 ± 4. There was no difference in brain density measurement for observer 1, ICP less than 20 (26.3 HU) versus ICP 20 or greater (27.4 HU, P = 0.545) or for CPP less than 70 (27.1 HU) versus CPP 70 or greater (26.2, P = 0.624). Similarly, there was no difference for observer 2, ICP less than 20 (26.8 HU) versus ICP 20 or greater (27.4, P = 0.753) and CPP less than 70 (27.6 HU) versus CPP 70 or greater (26.2, P = 0.436). CT-measured brain density does not correlate with elevated ICP or depressed CPP and cannot predict patients with traumatic brain injury who would benefit from invasive ICP monitoring.

PVDF Sensor: Design and Development for Use as Intracranial Pressure Monitoring Device

2009 ◽  
Author(s):  
V. Vijaywargi ◽  
R. Proffitt ◽  
P. Mane ◽  
K. Mossi ◽  
K. Ward ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Intracranial Pressure ◽  
Applied Pressure ◽  
Monitoring Device ◽  
Risk Of Infection ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
High Frequencies ◽  
Novel Method ◽  
The Brain

The brain is surrounded by cerebrospinal fluid, and when a brain tumor or a traumatic brain injury has occurred, intracranial pressure, ICP, is developed. Monitoring ICP non-invasively is a challenge. Currently, a probe is inserted through the skull, running the risk of infection, bleeding, and damage to the brain tissue with residual neurologic effects. A novel method to measure ICP using actuators and sensors has been proposed where the skull is vibrated at high frequencies and the receiving signal is measured at the surface eyelid. A design of experiments approach is used to develop the sensor part of the ICP monitoring device so that gain can be maximized using factors such as area, thickness, electrode, and applied pressure. In addition, sensor packaging is optimized to minimize dampening of the signal and ensure durability, reliability, and repeatability of the measurements. Results of this study showed that for a range of areas and thicknesses with Cu-Ni electrodes packaged with super strength durable tape are the optimum factors for the ICP sensor. These parameters are then incorporated into a design that allows ease of application and consistency of the measurements.

Experience with Althesin in the management of persistently raised ICP following severe head injury

1986 ◽  
Vol 64 (3) ◽  
pp. 414-419 ◽  
Author(s):  
Ross Bullock ◽  
James R. van Dellen ◽  
Derek Campbell ◽  
Ian Osborn ◽  
S. Gustav Reinach
Keyword(s):  
Patient Outcome ◽  
Head Injury ◽  
Intracranial Pressure ◽  
Cerebral Perfusion ◽  
Severe Head Injury ◽  
Perfusion Pressure ◽  
Surgical Decompression ◽  
Icp Monitoring ◽  
Content Type ◽  
Fine Print

✓ Of 243 patients who underwent intracranial pressure (ICP) monitoring after severe head injury, 42 (17%) were found to have severe persistently raised ICP, in spite of hyperventilation, mannitol, and surgical decompression. Althesin was infused to reduce ICP in these patients. This agent was shown to be effective and safe in reducing ICP, and a significant improvement in cerebral perfusion pressure was demonstrated. In this respect, Althesin may be more effective than barbiturates. However, no improvement in patient outcome was demonstrated in this series.

scholarly journals RESUSITASI CAIRAN PADA CEDERA KEPALA

2015 ◽  
Vol 4 (1) ◽  
pp. 75-83
Author(s):  
Nurma Afiani
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Intracranial Pressure ◽  
Head Trauma ◽  
Saline Solution ◽  
Pressure Head

Cedera kepala merupakan salah satu kasus trauma yang memerlukan perhatian khusus dalam resusitasi cairan. Jumlah dan jenis cairan yang digunakan dalam proses resusitasi cedera kepala harus diperhatikan secara cermat, cairan yang digunakan harus mampu mengontrol tekanan intrakranial (TIK) otak, dapat mengurangi edema otak dan tidak menimbulkan efek samping bagi organ tubuh yang lain. Jenis dan jumlah cairan resusitasi pada kasus cedera kepala masih menjadi topik kontroversial sehingga literatur mengenai cairan resusitasi pada kasus cedera kepala masih terbatas. Artikel berikut ini akan menyajikan jenis dan jumlah cairan yang tepat untuk resusitasi cedera kepala berdasarkan review hasil penelitian terkait yang disajikan dalam EBSCO, PROQUEST, CENGANGE dalam rentang 10 tahun terakhir. Kata kunci yang digunakan adalah ‘fluid resusication’, ‘intracranial pressure’, ‘head injury’, ‘traumatic brain injury’, ‘head trauma’. Artikel diseleksi berdasarkan kesesuaiannya dengan tujuan yakni mengidentifikasi jenis dan jumlah cairan resusitasi. Hasil review menunjukkan bahwa tidak ada suatu jenis cairan resusitasi ‘ideal’ yang dapat digunakan untuk semua kasus trauma. Metode pemberian cairan (waktu, volume dan tujuan yang diharapkan) lebih penting dibandingkan dengan jenis cairan itu sendiri. Hypertonis saline solution (HTS) menjadi salah satu jenis cairan resusitasi yang dapat digunakan dengan beberapa pilihan dosis sebagai berikut: 3% HTS 3ml/kg secara IV selama 10-20 menit; dua bolus 250ml 5% HTS atau 500ml 3% HTS; 4-5ml/kg HTS. HTS sebagai cairan resusitasi cedera kepala unggul dalam menurunkan edema otak dan tidak menimbulkan efek berbahaya bagi organ lain (renoprotective agent).  

scholarly journals Contralateral Cochlear Labyrinthine Concussion without Temporal Bone Fracture: Unusual Posttraumatic Consequence

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
I. M. Villarreal ◽  
D. Méndez ◽  
J. M. Duque Silva ◽  
P. Ortega del Álamo
Keyword(s):  
Hearing Loss ◽  
Head Injury ◽  
Sensorineural Hearing Loss ◽  
Temporal Bone ◽  
Head Trauma ◽  
Bone Fractures ◽  
Contralateral Side ◽  
Sensorineural Hearing ◽  
Temporal Bone Fracture ◽  
Blunt Head Trauma

Introduction. Labyrinthine concussion is a term used to describe a rare cause of sensorineural hearing loss with or without vestibular symptoms occurring after head trauma. Isolated damage to the inner ear without involving the vestibular organ would be designated as a cochlear labyrinthine concussion. Hearing loss is not a rare finding in head trauma that involves petrous bone fractures. Nevertheless it generally occurs ipsilateral to the side of the head injury and extraordinarily in the contralateral side and moreover without the presence of a fracture.Case Report. The present case describes a 37-year-old patient with sensorineural hearing loss and tinnitus in his right ear after a blunt head trauma of the left-sided temporal bone (contralateral). Otoscopy and radiological images showed no fractures or any abnormalities. A severe sensorineural hearing loss was found in his right ear with a normal hearing of the left side.Conclusion. The temporal bone trauma requires a complete diagnostic battery which includes a neurotologic examination and a high resolution computed tomography scan in the first place. Hearing loss after a head injury extraordinarily occurs in the contralateral side of the trauma as what happened in our case. In addition, the absence of fractures makes this phenomenon even more unusual.

On the feasibility of a liquid crystal polymer pressure sensor for intracranial pressure measurement

2019 ◽  
Vol 64 (5) ◽  
pp. 543-553
Author(s):  
Preedipat Sattayasoonthorn ◽  
Jackrit Suthakorn ◽  
Sorayouth Chamnanvej
Keyword(s):  
Liquid Crystal ◽  
Intracranial Pressure ◽  
Minimally Invasive ◽  
Pressure Sensor ◽  
Microelectromechanical Systems ◽  
Liquid Crystal Polymer ◽  
Monitoring Device ◽  
Icp Monitoring ◽  
Ongoing Research ◽  
Crystal Polymer

Abstract Intracranial pressure (ICP) monitoring is crucial in determining the appropriate treatment in traumatic brain injury. Minimally invasive approaches to monitor ICP are subject to ongoing research because they are expected to reduce infections and complications associated with conventional devices. This study aims to develop a wireless ICP monitoring device that is biocompatible, miniature and implantable. Liquid crystal polymer (LCP) was selected to be the main material for the device fabrication. This study considers the design, fabrication and testing of the sensing unit of the proposed wireless ICP monitoring device. A piezoresistive pressure sensor was designed to respond to 0–50 mm Hg applied pressure and fabricated on LCP by standard microelectromechanical systems (MEMS) procedures. The fabricated LCP pressure sensor was studied in a moist environment by means of a hydrostatic pressure test. The results showed a relative change in voltage and pressure from which the sensor’s sensitivity was deduced. This was a proof-of-concept study and based on the results of this study, a number of recommendations for improving the considered sensor performance were made. The limitations are discussed, and future design modifications are proposed that should lead to a complete LCP package with an improved performance for wireless, minimally invasive ICP monitoring.

scholarly journals Study of outcome of patients sustaining depressed skull fracture following blunt head trauma

2018 ◽  
Vol 14 (2) ◽  
pp. 81-84
Author(s):  
Bidur KC ◽  
Bikram Shakya ◽  
Amit Thapa
Keyword(s):  
Head Injury ◽  
Head Trauma ◽  
Skull Fracture ◽  
Simple Type ◽  
Mild Head Injury ◽  
Focal Neurological Deficit ◽  
Wound Debridement ◽  
Depressed Skull Fracture ◽  
Blunt Head Trauma ◽  
Compound Type

ABSTRACTBackground: One of the common neurosurgical conditions is depressed skull fracture. It could be simple or compound type. This study aims to assess the outcome of the patients with depressed skull fracture.Material and Methods: Retrospective cohort study of the patients admitted with depressed skull fracture after sustaining blunt head trauma was done. Data were collected with regard to age, sex, mode of injury, time delay, Glasgow coma scale (GCS), epilepsy, focal neurological deficit, CT scan findings, treatment given, infection and Glasgow outcome scale (GOS). Results: Total of 50 patients were included, of which 68% were male and 32% were female with mean age of 21.02 ± 18.78 years. Fall was the commonest mode of injury constituting 60% of patients, 80% of the patients presented within 12 hours of injury and 86% of them sustained mild head injury. Fracture was of compound type in 56% and simple type in 44%. Wound debridement and suturing was performed in 26% and Craniotomy and elevation was done in 42%. Dural tear was observed in 47% who were operated. Early epilepsy was seen in 4% and late epilepsy in 2% and infection rate of 2%. Outcome was Favorable in 98% patients. Significant correlation noted between admission GCS with GOS (p=0.006) whereas no correlation was seen between time of presentation with infection (p=0.09).Conclusion: Mild head injury was the commonest form of presentation. Most of the patients have unfavorable outcome and with low risk of infection and epilepsy. Good admission GCS correlated with favorable outcome.Keywords: blunt head trauma; depressed skull fracture; epilepsy; infection; outcome.

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