Intracranial Pressure Waveform Morphology and Intracranial Adaptive Capacity

2008 ◽  
Vol 17 (6) ◽  
pp. 545-554 ◽  
Author(s):  
Jun-Yu Fan ◽  
Catherine Kirkness ◽  
Paolo Vicini ◽  
Robert Burr ◽  
Pamela Mitchell
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Adaptive Capacity ◽  
Severe Traumatic Brain Injury ◽  
Controlled Trial ◽  
Pressure Monitor ◽  
Data Set ◽  
Prime Concern ◽  
Intracranial Pressure Waveform

Background Intracranial hypertension due to primary and secondary injuries is a prime concern when providing care to patients with severe traumatic brain injury. Increases in intracranial pressure vary depending on compensatory processes within the craniospinal space, also referred to as intracranial adaptive capacity. In patients with traumatic brain injury and decreased intracranial adaptive capacity, intracranial pressure increases disproportionately in response to a variety of stimuli. However, no well-validated measures are available in clinical practice to predict the development of such an increase. Objectives To examine whether P2 elevation, quantified by determining the P2:P1 ratio (=0.8) of the intracranial pressure pulse waveform, is a unique predictor of disproportionate increases in intracranial pressure on a beat-by-beat basis in the 30 minutes preceding the elevation in patients with severe traumatic brain injury, within 48 hours after deployment of an intracranial pressure monitor. Methods A total of 38 patients with severe traumatic brain injury were sampled from a randomized controlled trial of cerebral perfusion pressure management in patients with traumatic brain injury or subarachnoid hemorrhage. Results The P2 elevation was not only present before the disproportionate increase in pressure, but also appeared in the comparison data set (within-subject without such a pressure increase). Conclusions P2 elevation is not a reliable clinical indicator to predict an impending disproportionate increase in intracranial pressure.

scholarly journals An Approach to Determining Intracranial Pressure Variability Capable of Predicting Decreased Intracranial Adaptive Capacity in Patients With Traumatic Brain Injury

2010 ◽  
Vol 11 (4) ◽  
pp. 317-324 ◽  
Author(s):  
Jun-Yu Fan ◽  
Catherine Kirkness ◽  
Paolo Vicini ◽  
Robert Burr ◽  
Pamela Mitchell
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Adaptive Capacity ◽  
Controlled Trial ◽  
Relevant Information ◽  
Data Set ◽  
Bedside Monitoring ◽  
Increased Risk ◽  
Severe Tbi

Nurses caring for traumatic brain injury (TBI) patients with intracranial hypertension (ICH) recognize that patients whose intracranial adaptive capacity is reduced are susceptible to periods of disproportionate increase in intracranial pressure (DIICP) in response to a variety of stimuli. It is possible that DIICP signals potential secondary brain damage due to sustained or intermittent ICH. However, there are few clinically accessible intracranial pressure (ICP) measurement parameters that allow nurses and other critical care clinicians to identify patients at risk of DIICP. The purpose of this study was to investigate whether there are specific minute-to-minute trends in ICP variability during the first 48 hr of monitoring that might accurately predict DIICP in patients with severe TBI. A total of 38 patients with severe TBI were sampled from the data set of a randomized controlled trial testing bedside monitoring displays and cerebral perfusion pressure management in individuals with TBI or sub-arachnoid hemorrhage. The investigators retrospectively examined the rates of change (slope) in mean, standard deviation, and variance of ICP on a 1-min basis for 30 consecutive min prior to a specified DIICP event. There was a significantly increasing linear and quadratic slope in mean ICP prior to the development of DIICP, compared with the comparison data set (p < .05). It is feasible to display moving averages in modern bedside monitoring. Such an arrangement may be useful to provide visual displays that provide immediate clinically relevant information regarding the patients with decreased adaptive capacity and therefore increased risk of DIICP.

Statewide Trends in Intracranial Pressure Monitor Use in 36,915 Patients with Severe Traumatic Brain Injury in a Mature Trauma System over the Past 18 Years

2019 ◽  
Vol 130 ◽  
pp. e166-e171 ◽  
Author(s):  
Nikolaos Mouchtouris ◽  
Justin Turpin ◽  
Nohra Chalouhi ◽  
Fadi Al Saiegh ◽  
Thana Theofanis ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Severe Traumatic Brain Injury ◽  
Trauma System ◽  
Pressure Monitor ◽  
The Past

Intracranial Pressure Monitoring in Severe Traumatic Brain Injury

2018 ◽  
pp. 39-44
Author(s):  
Thomas Peponis ◽  
David R. King
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Severe Traumatic Brain Injury ◽  
Controlled Trial ◽  
Survival Rates ◽  
Intracranial Pressure Monitoring ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Neuropsychological Status

The study “A Trial of Intracranial-Pressure Monitoring in Traumatic Brain Injury” published by Chesnut et al. aimed to resolve the debatable issue of the benefit of intracranial-pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). The authors designed a randomized controlled trial that was conducted in Latin America. A total of 324 patients admitted with severe TBI were randomly assigned to two groups. The first group (n = 157) was managed with ICP monitoring, using an intraparenchymal monitor. The goal was to keep the ICP below 20 mm Hg. Management of patients comprising the second group (n = 167) was based solely on serial clinical examinations and imaging tests. It was hypothesized that ICP-monitoring would result in increased survival rates, plus improved functional and neuropsychological status at 6-months after the injury. Additionally, the authors hypothesized that complication rates would be decreased and the ICU length of stay shorter.

Selection of children with ultra-severe traumatic brain injury for neurosurgical intervention

2019 ◽  
Vol 23 (6) ◽  
pp. 670-679
Author(s):  
Krista Greenan ◽  
Sandra L. Taylor ◽  
Daniel Fulkerson ◽  
Kiarash Shahlaie ◽  
Clayton Gerndt ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decision Tree ◽  
Prediction Model ◽  
Severe Traumatic Brain Injury ◽  
Pupillary Response ◽  
Data Set ◽  
Robust Model ◽  
Gcs Score ◽  
Combined Data

OBJECTIVEA recent retrospective study of severe traumatic brain injury (TBI) in pediatric patients showed similar outcomes in those with a Glasgow Coma Scale (GCS) score of 3 and those with a score of 4 and reported a favorable long-term outcome in 11.9% of patients. Using decision tree analysis, authors of that study provided criteria to identify patients with a potentially favorable outcome. The authors of the present study sought to validate the previously described decision tree and further inform understanding of the outcomes of children with a GCS score 3 or 4 by using data from multiple institutions and machine learning methods to identify important predictors of outcome.METHODSClinical, radiographic, and outcome data on pediatric TBI patients (age < 18 years) were prospectively collected as part of an institutional TBI registry. Patients with a GCS score of 3 or 4 were selected, and the previously published prediction model was evaluated using this data set. Next, a combined data set that included data from two institutions was used to create a new, more statistically robust model using binomial recursive partitioning to create a decision tree.RESULTSForty-five patients from the institutional TBI registry were included in the present study, as were 67 patients from the previously published data set, for a total of 112 patients in the combined analysis. The previously published prediction model for survival was externally validated and performed only modestly (AUC 0.68, 95% CI 0.47, 0.89). In the combined data set, pupillary response and age were the only predictors retained in the decision tree. Ninety-six percent of patients with bilaterally nonreactive pupils had a poor outcome. If the pupillary response was normal in at least one eye, the outcome subsequently depended on age: 72% of children between 5 months and 6 years old had a favorable outcome, whereas 100% of children younger than 5 months old and 77% of those older than 6 years had poor outcomes. The overall accuracy of the combined prediction model was 90.2% with a sensitivity of 68.4% and specificity of 93.6%.CONCLUSIONSA previously published survival model for severe TBI in children with a low GCS score was externally validated. With a larger data set, however, a simplified and more robust model was developed, and the variables most predictive of outcome were age and pupillary response.

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