Highlighting intracranial pressure monitoring in patients with severe acute brain trauma

Abstract

SUMMARY -Intracranial pressure (ICP) monitoring was carried out in 100 patients with severe acute brain trauma, primarily by means of a subarachnoid catheter. Statistical associations were evaluated between maximum ICP values and: 1) Glasgow Coma Scale (GCS) scores; 2) findings on computed tomography (CT) scans of the head; and 3) mortality. A significant association was found between low GCS scores (3 to 5) and high ICP levels, as well as between focal lesions on CT scans and elevated ICP. Mortality was significantly higher in patients with ICP > 40 mm Hg than in those with ICP < 20 mm Hg.KEY WORDS: head injury, intracranial pressure, coma. Ressaltando a monitorização da pressão intracraniana em pacientes com traumatismo cerebral agudo graveRESUMO -Monitorização da pressão intracraniana (PIC) foi adotada em 100 pacientes com traumatismo cerebral agudo grave, usando-se preferencialmente um catéter subaracnóide. Associações estatísticas foram avaliadas entre valores máximos de PIC e : 1) número de pontos na Escala de Coma de Glasgow (ECG); 2) achados na tomografia computadorizada (TC) da cabeça; e 3) mortalidade. Encontrou-se associação significante entre baixo número de pontos (3 a 5) na ECG e PIC elevada, assim como entre lesões focais na TC e hipertensão intracraniana. A mortalidade foi significantemente maior em pacientes com PIC > 40 mm Hg do que naqueles com PIC < 20 mm Hg. PALAVRAS-CHAVE: traumatismo cerebral, pressão intracraniana, coma. Routine ICP monitoring has been adopted at our institution since 1989. Over the years, our preference has been for subarachnoid catheter monitoring. This technique appears to satisfactorily comply with clinical requirements, particularly because it is practical, inexpensive, and carries just a small risk of complications. The present work is an outgrowth of our experience. Attempts were Continuous monitoring of intracranial pressure (ICP) in humans was

Glasgow outcome scale at hospital discharge as a prognostic index in patients with severe traumatic brain injury

“…In accordance with another clinical reports, the main cause of TBI was motor vehicle accidents (74% of the cases) 18,24,25 . The socioeconomic impact of TBI was also very impressive, as long as in the present investigation it was observed that almost 50% of the injured patients have shown some degree of long-term neurological sequelae or have been dead according to GOS-LATE.…”

“…Although in the medical literature it could be found many studies that have employed GOS for the long-term follow-up of TBI patients' outcome 24,25,[28][29][30] , the correlation between GOS-HD and GOS-LATE is scarcely reported 31 . As a prognostic index tool, GOS-HD has shown to be highly useful in this investigation, indicating a possibility of later neurological outcome improvement 12 times higher in those patients classified as MD and GR when compared to those that have shown VS and SD (p=0.0312).…”

Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring

“…5 The significance of intracranial hypertension in predicting outcome from TBI has been well studied since the 1960s. 2,4,12,17,19,20 Aside from its prognostic value, ICP monitoring also guides early diagnosis and management of intracranial hypertension. 29 Furthermore, there are now several evidence-based studies showing that ICP monitoring, when used in a protocol-based manner in neurosurgical ICUs, leads to improved outcomes in adjusted mortality rates for patients with severe TBI.…”

Which is Safer to Avoid an Increase in ICP After Endotracheal Suctioning in Severe Head Injury: Intravenous or Endotracheal Lidocaine?

“…Patients were all intubated, mechanically ventilated, sedated and were maintained supine with the head elevated at 30 o and aligned with the trunk, according to protocols previously defined [3,5]. Mechanical ventilation was adjusted to maintain arterial oxygen saturation (SaO 2 ) above 94% and partial pressure of arterial carbon dioxide (PaCO 2 ) between 35 and 40 mmHg with positive end-expiratory pressure (PEEP) of 5 cm H 2 O.…”

“…Improved outcome results when these secondary, delayed insults, resulting in reduced cerebral perfusion to the injured brain, are prevented by avoiding an increase in intracranial pressure (ICP) and a decrease in cerebral perfusion pressure (CPP). This is reflected in the progressive and significant reduction in severe TBI mortality and morbidity and worldwide preoccupation in relation to prevention and best treatment [1][2][3][4][5].…”