Compare the Intracranial Pressure Trend after the  Decompressive Craniectomy between Massive Intracerebral Hemorrhagic and Major Ischemic Stroke Patients

Huh, Jae Won; Yang, Suk‐Woo; Huh, Han-Yong; Ahn, Jaekun; Cho, Kwang-Wook; Kim, Young Woo; Kim, Sung-Lim; Kim, Jong-Tae; Yoo, Do Sung; Park, Hae Kwan; Ji, Cheol

doi:10.3340/jkns.2017.0224

Cited by 3 publications

(2 citation statements)

References 45 publications

(96 reference statements)

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“…Compared to TBI patients, the monitoring of ICP in stroke patients remains poorly investigated and is not routinely recommended in patients with coma after hemorrhagic or ischemic stroke (24,25). There is evidence that ICP can be elevated even following decompressive hemicraniectomy or after hematoma removing (26,27).…”

Section: Discussionmentioning

confidence: 99%

Impact of intensive care-related factors on outcome in stroke patients, results from the population-based Brest Stroke Registry: an observational study

Ariès

Bailly²,

Baudic

et al. 2023

Preprint

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Background Little is known on the burden of ICU care for stroke patients. The aim of this study was to provide a description of management strategies, resource use, complications and their association with prognosis of stroke patients admitted to ICU. Methods Using a population-based stroke registry, we analyzed consecutive stroke patients admitted to 3 ICU with at least one organ failure between 2008 and 2017. The study period was divided into two periods corresponding to the arrival of mechanical reperfusion technique. Predictors of ICU mortality were separately assessed in two multivariable logistic regression models, a “clinical model” and an “intervention model”. The same analysis was performed for predictors of functional status at hospital discharge. Results 215 patients were included. Stroke etiology was ischemia in 109 patients (50.7%) and hemorrhage in 106 patients (49.3%). Median NIHSS score was 20.0 (9.0; 40.0). The most common reason for ICU admission was coma (41.2%) followed by acute circulatory failure (41%) and respiratory failure (27.4%). 112 patients (52%) died in the ICU and 20 patients (11.2%) had a good functional outcome (mRS≤3) at hospital discharge. In the "clinical model,” factors independently associated with ICU mortality were: age (OR = 1.03 [95%CI, 1.0 to 1.06]; p=0.04) and intracranial hypertension (OR = 6.89 [95%CI, 3.55 to 13.38]; p<0.0001). In the “intervention model,” the need for invasive mechanical ventilation (OR = 7.39 [95%CI, 1.93 to 28.23]; p=0.004), the need for vasopressor therapy (OR = 3.36 [95%CI, 1.5 to 7.53]; p=0.003) and decision of withholding life support treatments (OR = 19.24 [95%CI, 7.6 to 48.65]; p<0.0001) were associated with bad outcome. Conclusion Our study showed the very poor prognosis of acute stroke patients admitted to ICU. These results also suggest that the clinical evolution of these patients during ICU hospitalization may provide important information for prognostication.

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Section: Discussionmentioning

confidence: 99%

Impact of intensive care-related factors on outcome in stroke patients, results from the population-based Brest Stroke Registry: an observational study

Ariès

Bailly²,

Baudic

et al. 2023

Preprint

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“…Besides, both medical and decompression treatment aims to restore regional perfusion, correct midline shift, and reduce brainstem pressure (2). Indeed, DC may be chosen in any disease situation causing increased intracranial pressure (11,12). DC was shown to have important effects on mortality in the patients with malign MCA infarct especially if performed in the first 48 hours of the event (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

What is the optimum time to decompressive surgery in the patients with malignant middle cerebral artery infarction?

Yücetaş¹,

Üçler²,

Kafadar³

et al. 2019

Ann Med Res

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In the patients with malignant middle cerebral artery (MCA) infarctions, the mortality was as high as 70% with conservative treatment. Decompressive craniectomy (DC) was shown to decrease mortality especially in 48 hours. We aimed to investigate both the effect of decompression time and the size of craniectomy on the mortality in this patient group. Material and Methods: 45 adult patients underwent to DC due to malignant MCA infarction were evaluated in this study. The demographic and clinical features were recorded retrospectively. The patients were splitted into three groups: Group 1, DC in the first 24 hours; group 2, in 24-48th hours; group3, in 48-96th hours of the admission. The size of craniectomy was the same as the infarct (standard), or it was two centimeters larger than the size of infarct (larger). Results: Of all patients, 53.3% (n=24) was female; and mean age of the sample was 67.38±4.76. 66.7% (n=30) of the patients died due to malign MCA infarction. The size of craniectomy was larger in 26.7% (n=12), and was standard in the others. Mean time to surgery was 43.07±29.87 hours. Mortality rate was minimum in group 2 (p=0.01). The patients undergoing to larger craniectomy survived longer than the others, but the difference was non-significant (p=0.06). Conclusion: We suggested that not the approach of "surgery as soon as possible" but the surgery between 24-48th hours of the admission would be the optimal approach. This issue is especially important, because earlier or later interventions not only have a less benefit on the outcome but also may lead several unnecessary complications.

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Invasive and Noninvasive Techniques for Intracranial Pressure Monitoring After Decompressive Craniectomy: A Systematic Review and Meta-Analysis

Palavani,

Alves Neto,

Batista

et al. 2024

World Neurosurgery

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Compare the Intracranial Pressure Trend after the Decompressive Craniectomy between Massive Intracerebral Hemorrhagic and Major Ischemic Stroke Patients

Cited by 3 publications

References 45 publications

Impact of intensive care-related factors on outcome in stroke patients, results from the population-based Brest Stroke Registry: an observational study

Impact of intensive care-related factors on outcome in stroke patients, results from the population-based Brest Stroke Registry: an observational study

What is the optimum time to decompressive surgery in the patients with malignant middle cerebral artery infarction?

Invasive and Noninvasive Techniques for Intracranial Pressure Monitoring After Decompressive Craniectomy: A Systematic Review and Meta-Analysis

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