Monitoring intracranial pressure utilizing a novel pattern of brain multiparameters in the treatment of severe traumatic brain injury

Abstract

The aim of the study was to evaluate the clinical value of multiple brain parameters on monitoring intracranial pressure (ICP) procedures in the therapy of severe traumatic brain injury (sTBI) utilizing mild hypothermia treatment (MHT) alone or a combination strategy with other therapeutic techniques. A total of 62 patients with sTBI (Glasgow Coma Scale score <8) were treated using mild hypothermia alone or mild hypothermia combined with conventional ICP procedures such as dehydration using mannitol, hyperventilation, and decompressive craniectomy. The multiple brain parameters, which included ICP, cerebral perfusion pressure, transcranial Doppler, brain tissue partial pressure of oxygen, and jugular venous oxygen saturation, were detected and analyzed. All of these measures can control the ICP of sTBI patients to a certain extent, but multiparameters associated with brain environment and functions have to be critically monitored simultaneously because some procedures of reducing ICP can cause side effects for long-term recovery in sTBI patients. The result suggested that multimodality monitoring must be performed during the process of mild hypothermia combined with conventional ICP procedures in order to safely target different clinical methods to specific patients who may benefit from an individual therapy.

Effects of hypothermia and hypothermia combined with hypocapnia on cerebral tissue oxygenation in piglets

“…Contrary to hypothermia alone, hypothermia with additional hypocapnia led to a significant decrease in PtO 2 . This is in accordance with previous reports showing a decrease in ICP but also in PtO 2 when mild hypothermia was combined with hypocapnia in humans suffering severe traumatic brain injury 20 . Unfortunately, the latter study does not provide rSO 2 data.…”

Monitoring brain multiparameters and hypothermia in severe traumatic brain injury

“…We read with great interest the recent study by Sun et al1 published in Neuropsychiatric Disease and Treatment . Intracranial hypertension (ICH) remains the most common cause of death in patients with traumatic brain injury (TBI) 1.…”

“…Intracranial hypertension (ICH) remains the most common cause of death in patients with traumatic brain injury (TBI) 1. After the trauma, secondary injuries arise due to perfusion and molecular changes that begin after the moment of the trauma resulting from the interaction of intracerebral and extracerebral factors, which add to the neuronal injury.…”

“…After the trauma, secondary injuries arise due to perfusion and molecular changes that begin after the moment of the trauma resulting from the interaction of intracerebral and extracerebral factors, which add to the neuronal injury. Hypotension, hypoglycemia, hypercapnia, respiratory hypoxia, anemic hypoxia, and electrolyte disturbances are the main factors associated with secondary injury, which can lead to ICH and cerebral hypoxia, thereby worsening the morbidity and death rates associated with brain injury 1,2. In this paper, the authors have discussed the multimodality intracranial monitoring carried out in 62 severe TBI patients, with evidence of hypothermia as a therapeutic strategy to adequately control intracranial pressure (ICP).…”

“…It has already been established that adequate ICP management is important for the better outcome of severe TBI patients 1. However, it is important to emphasize that patients with severe TBI need complex management.…”