Measurement of intracranial pressure and short-term outcomes of patients with traumatic brain injury: a propensity-matched analysis

Abstract

Objective To assess the impact of intracranial pressure monitoring on the short-term outcomes of traumatic brain injury patients.Methods Retrospective observational study including 299 consecutive patients admitted due to traumatic brain injury from January 2011 through July 2012 at a Level 1 trauma center in São Paulo, Brazil. Patients were categorized in two groups according to the measurement of intracranial pressure (measured intracranial pressure and non-measured intracranial pressure groups). We applied a propensity-matched analysis to adjust for possible confounders (variables contained in the Crash Score prognostic algorithm).Results Global mortality at 14 days (16%) was equal to that observed in high-income countries in the CRASH Study and was better than expected based on the CRASH calculator score (20.6%), with a standardized mortality ratio of 0.77. A total of 28 patients received intracranial pressure monitoring (measured intracranial pressure group), of whom 26 were paired in a 1:1 fashion with patients from the non-measured intracranial pressure group. There was no improvement in the measured intracranial pressure group compared to the non-measured intracranial pressure group regarding hospital mortality, 14-day mortality, or combined hospital and chronic care facility mortality. Survival up to 14 days was also similar between groups.Conclusion Patients receiving intracranial pressure monitoring tend to have more severe traumatic brain injuries. However, after adjusting for multiple confounders using propensity scoring, no benefits in terms of survival were observed among intracranial pressure-monitored patients and those managed with a systematic clinical protocol.

Management of intracranial hypertension in patients neurocriticos: integrative review

“…In summary the possible effects adeversos stand out as isquemia cerebral, 6,13 hypoxia/hypoxemia cerebral, [14][15][16][17][18][19][20][21][22] The main secondary causes (extracranial) are airway obstruction; Hypoxia or hypercapnia or hypercarbia (hypoventilation); Hypertension (pain / cough) and hypotension (hypovolemia / sedation); Posture of the patient (head rotation); hyperpyrexia; seizures; And metabolic drugs (e.g., tetracycline, rofecoxib, divalproex sodium, lead poisoning); Others (eg, cerebral edema high altitude, liver failure). The causes of HIC postoperative can present as a mass lesion (hematoma); Edema; Increased cerebral blood volume (vasodilation); LCR disorders.…”

“…The causes of HIC postoperative can present as a mass lesion (hematoma); Edema; Increased cerebral blood volume (vasodilation); LCR disorders. 5,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The most commonly used technique in clinical practice to monitor the peak involves an intraventricular or intraparenchymal catheter system, which is still considered the gold standard for monitoring ICP. These advances in PIC monitoring technique provides a variety of methods to assess ICP.…”

Hydrocephalus: the role of cerebral aquaporin-4 channels and computational modeling considerations of cerebrospinal fluid

“…For physicians, ICP is a well-recognized clinical quantity that can be measured with spinal tap or monitored acutely with pressure sensors. 36,74,114 In computational models of intracranial dynamics, pressure differences are calculated using the equations of motion for the CSF, the NavierStokes equations. A recent review by Linninger et al summarized models of CSF dynamics and diseases.…”

Evolução da vítima com trauma cranioencefálico na sala de emergência

“…Os traumas envolvendo veículos são as causas mais comuns de TCE (4,7,8,10,11,25) e a incidência dessa lesão está aumentando no mundo, especialmente nos países em desenvolvimento, em decorrência do uso crescente de transporte motorizado (1,3,5,21) .…”

“…O maior tempo de permanência na SE esteve relacionado com uso de suporte hemodinâmico nesse serviço. (1,2,3,4,5,6,7,8,9,10,11,12,13) . Representa um grande problema de saúde em todo o mundo, por causar muitas mortes e incapacidades persistentes (14) .…”