A Randomized and Blinded Single-Center Trial Comparing the Effect of Intracranial Pressure and Intracranial Pressure Wave Amplitude-Guided Intensive Care Management on Early Clinical State and 12-Month Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage

Eide, Per Kristian; Bentsen, Gunnar; Sorteberg, Angelika; Marthinsen, Pål Bache; Stubhaug, Audun; Sorteberg, Wilhelm

doi:10.1227/neu.0b013e318227e0e1

Cited by 41 publications

(34 citation statements)

References 35 publications

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“…The patients were retrieved from a previously reported singlecenter prospective, randomized, and blinded clinical trial [9] carried out at the Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway, during the period November 2005-January 2008. The study was approved by the Regional Committee for Medical and Health Research Ethics (REK) of Health Region South-East, Norway (S-05184), and was registered in Clinical-Trials.gov: NCT00248690.…”

Section: Patients and Study Designmentioning

confidence: 99%

“…The decision for shunting was based on our institutional treatment algorithm and has been described in detail previously [9,32]. At the time of deciding whether to implant a shunt or not, there were no known studies on the topic.…”

Section: Assessment Of Shunt Dependencymentioning

confidence: 99%

“…In the present study we re-analyzed the results from a single-center, prospective, randomized and blinded clinical trial (Clinical Trials NCT00248690) [9] that investigated different modes of ICP management in aSAH patients. Based on the results of this trial, we determined whether pre-defined variables were risk factors for shunt dependency.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of shunt dependency after aneurysmal subarachnoid hemorrhage: results of a single-center clinical trial

Erixon

Sorteberg

et al. 2014

Acta Neurochir

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Section: Patients and Study Designmentioning

confidence: 99%

Section: Assessment Of Shunt Dependencymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of shunt dependency after aneurysmal subarachnoid hemorrhage: results of a single-center clinical trial

Erixon

Sorteberg

et al. 2014

Acta Neurochir

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“…20 From our clinical studies, we have defined the upper threshold of MWA as 4-5 mm Hg, and percentage of MWA > 5 mm Hg in > 10% of the recording time as indicative of impaired intracranial compliance. 16,22 Therefore, we consider the elevated MWA values in the underdrainage group as an indicator of impaired intracranial compliance. A key mechanism behind the effect of shunt placement may be improvement of impaired intracranial compliance.…”

Section: Icp Scores and Type Of Shunt Failurementioning

confidence: 99%

“…In addition, the elevated ICP wave amplitudes were comparable with the abnormal levels previously reported in other studies. 16,22 However, in this retrospective study, we have primarily described our results of monitoring ICP in patients with tentative shunt failure. A randomized study design is required to determine how ICP scores predict type of shunt failure.…”

Section: Icp Scores and Type Of Shunt Failurementioning

confidence: 99%

Intracranial pressure monitoring in pediatric and adult patients with hydrocephalus and tentative shunt failure: a single-center experience over 10 years in 146 patients

Sæhle

Eide

2015

JNS

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Shunt surgery is the primary treatment of pediatric and adult hydrocephalus, 42 although shunt failure requiring shunt revision is frequent. 2,8,12,45 Shunt failure may be accompanied by over-or underdrainage of CSF. When the shunt is draining too much CSF (overdrainage), symptoms such as headache and dizziness may arise. 9,37 However, symptoms such as headache and dizziness may also be caused by CSF underdrainage, e.g., due to obstruction of the CSF catheter. 10 The shunt valves with adjustable CSF opening pressure have been reported to reduce the occurrence of shunt failures. 48 However, in a recent randomized controlled dual-center trial, 39 we found the same rate of shunt complications and overdrainage symptoms in patients with hydrocephalus receiving a shunt with a fixed valve setting of 13 cm H 2 O, as compared with those in whom gradual lowering of the valve setting to a mean of 7 cm H 2 O was performed. These results highlight the need for a better understanding of how shunts influence in- obJect In patients with hydrocephalus and shunts, lasting symptoms such as headache and dizziness may be indicative of shunt failure, which may necessitate shunt revision. In cases of doubt, the authors monitor intracranial pressure (ICP) to determine the presence of over- or underdrainage of CSF to tailor management. In this study, the authors reviewed their experience of ICP monitoring in shunt failure. The aims of the study were to identify the complications and impact of ICP monitoring, as well as to determine the mean ICP and characteristics of the cardiac-induced ICP waves in pediatric versus adult over- and underdrainage. methods The study population included all pediatric and adult patients with hydrocephalus and shunts undergoing diagnostic ICP monitoring for tentative shunt failure during the 10-year period from 2002 to 2011. The patients were allocated into 3 groups depending on how they were managed following ICP monitoring: no drainage failure, overdrainage, or underdrainage. While patients with no drainage failure were managed conservatively without further actions, over- or underdrainage cases were managed with shunt revision or shunt valve adjustment. The ICP and ICP wave scores were determined from the continuous ICP waveforms.results The study population included 71 pediatric and 75 adult patients. There were no major complications related to ICP monitoring, but 1 patient was treated for a postoperative superficial wound infection and another experienced a minor bleed at the tip of the ICP sensor. Following ICP monitoring, shunt revision was performed in 74 (51%) of 146 patients, while valve adjustment was conducted in 17 (12%) and conservative measures without any actions in 55 (38%).Overdrainage was characterized by a higher percentage of episodes with negative mean ICP less than −5 to −10 mm Hg. The ICP wave scores, in particular the mean ICP wave amplitude (MWA), best differentiated underdrainage. Neither mean ICP nor MWA levels showed any significant association with age. coNclusioNs In this coho...

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Routine intracranial pressure monitoring in acute coma

Forsyth

Raper

Todhunter

2015

Cochrane Database of Systematic Reviews

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A Randomized and Blinded Single-Center Trial Comparing the Effect of Intracranial Pressure and Intracranial Pressure Wave Amplitude-Guided Intensive Care Management on Early Clinical State and 12-Month Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage

Cited by 41 publications

References 35 publications

Predictors of shunt dependency after aneurysmal subarachnoid hemorrhage: results of a single-center clinical trial

Predictors of shunt dependency after aneurysmal subarachnoid hemorrhage: results of a single-center clinical trial

Intracranial pressure monitoring in pediatric and adult patients with hydrocephalus and tentative shunt failure: a single-center experience over 10 years in 146 patients

Routine intracranial pressure monitoring in acute coma

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