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Prognostic significance of intracranial pressure monitoring and intracranial hypertension in severe brain trauma patients
Kosti? Aleksandar,Stefanovi? Ivan,Novak Vesna,Veselinovi? Dragan
Medicinski Pregled , 2011, DOI: 10.2298/mpns1110461k
Abstract: Since without prospective randomized studies it is not possible to have a clear attitude towards the importance of intracranial pressure monitoring, this study was aimed at examining the prognostic effect of the intracranial pressure monitoring and intracranial pressure oriented therapy in severe brain trauma patients, and at defining optimal intracranial pressure values for starting the treatment. Two groups of patients were treated in the study, one consisted of 32 patients undergoing intracranial pressure monitoring and the second group of 29 patients without intracranial pressure monitoring in the control group. The study was prospective with groups randomized. There were 53% survivals in the intracranial pressure monitored patients and 34% in the control group, with no significant difference in the survival rate between the two groups (χ2=2.11; p=0.15; p>0.05). The average intracranial pressure in the patients with intracranial hypertension who died was 27 mm Hg, while in the patients who survived the average intracranial pressure was significantly lower (Student’s t test: t=2.91; p=0.008; p<0.01) and it was 18 mm Hg. We recommend starting intracranial pressure oriented therapy when the patient’s intracranial pressure exceeds 18 mmHg during 2 hours of monitoring.
Severe head injuries and intracranial pressure monitoring outcome in Southern Iran  [cached]
Majid Reza Farrokhi,Mousa Taghipour
Journal of Research in Medical Sciences , 2006,
Abstract: BACKGROUND: Head injury is still a major cause of death and disability. Despite advances in intensive monitoring and clinical practice, little data is available to show the predictive value of intracranial pressure monitoring in assessment of the outcome of head injuries. This study was undertaken to evaluate this predictive value and is the first Iranian study in which ICP monitoring has been included. METHODS: In a prospective study from September 1999 to September 2003, all head- injured patients (53 patients) with GCS of 4-8 who were admitted to Nemazee Hospital of Shiraz University of Medical Sciences were included in this study. Subarachnoid screw method or ventricular catheter via ventriculostomy was used to determine intracranial pressure. Patients were monitored for 3 days and were followed for two years at 6-month intervals. RESULTS: Car accidents were the most common cause of head injury (43.3%) and 43.3% of patients had GCS of 8. Sixty percent of patients had abnormal intracranial pressure. The patients were most commonly in their first decade of life (18.8%) and 81% of patients were male. Controlling increased intracranial pressure was successful in 60% of patients and resulted in a decrease of mortality rate from 60% to 15%. CONCLUSIONS: Early treatment of increased intracranial pressure in head injury patients would be beneficial in reducing mortality and morbidity rates. KEY WORDS: Southern Iran, head injury, outcome, intracranial pressure.
Highlighting intracranial pressure monitoring in patients with severe acute brain trauma
Falc?o, Antonio L. E;Dantas Filho, Venancio P.;Sardinha, Luiz A. C.;Quagliato, Elizabeth M. A. B.;Dragosavac, Desanka;Araújo, Sebasti?o;Terzi, Renato G. G.;
Arquivos de Neuro-Psiquiatria , 1995, DOI: 10.1590/S0004-282X1995000300004
Abstract: 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.
Intraparenchymal intracranial pressure monitoring in patients with acute liver failure
Rabadán, Alejandra T.;Spaho, Natalia;Hernández, Diego;Gadano, Adrián;Santiba?es, Eduardo de;
Arquivos de Neuro-Psiquiatria , 2008, DOI: 10.1590/S0004-282X2008000300018
Abstract: background: elevated intracranial pressure (icp) is a common cause of death in acute liver failure (alf) and is determinant for decision-making regarding the timing of liver transplantation. the recommended type icp monitoring device is controversial in alf patients. epidural devices had less risk of hemorrhagic complications, but they are less reliable than intraparenchymal ones. method: twenty-three patients with alf were treated, and 19 of them received a liver transplant. seventeen patients had icp monitoring because of grade iii-iv encephalopathy. all patients received fresh plasma (2-3 units) before and during placing the intraparenchymal device. results: eleven cases (64.7%) had elevated icp, and 6 patients (35.2%) had normal values. one patient (5.9%) had an asymptomatic small intraparenchymal haemorrhage <1cm3 in ctscan, which did not prevent the liver transplantation. conclusion: in our experience, intraparenchymal icp monitoring in patients with alf seems to be an accurate method with a low risk of complications.
Intensive care management of head injury patients without routine intracranial pressure monitoring  [cached]
Santhanam R,Pillai Shibu,Kolluri Sastry,Rao U
Neurology India , 2007,
Abstract: Background: Head injury contributes significantly to mortality and morbidity in India. Evaluation of the available trauma care facilities may help improve outcome. Aim: To evaluate the factors influencing the mortality of patients with head injury who had intensive care management and evolve strategies to improve outcome. Setting and Design: Retrospective study in a tertiary hospital where intracranial pressure monitoring (ICPM) is not routinely practiced. Materials and Methods: All patients with head injury managed in the intensive care unit in a two-year period were included. The factors evaluated were age, vital signs, Glasgow Coma scale score (GCS) at admission, pupillary light reflex (PR), oculocephalic reflex (OCR), hemodynamic stability, computerized tomography (CT) findings, diabetes mellitus, anemia, infections and abnormalities of serum sodium. Results: We analyzed 208 patients (202 without ICPM). In-hospital mortality was 64 (31%). Only 24 (11.5%) patients were admitted within one hour of injury, while one-third arrived after six hours. The clinical factors (at admission) that influenced mortality included age, GCS, PR, OCR and diastolic blood pressure (DBP). Effacement of the basal cisterns in the initial and repeat CT scans, hyperglycemia, hemodynamic instability and serum sodium imbalances were associated with higher mortality. The independent predictors of mortality by logistic regression were initial GCS, DBP, hemodynamic instability and effacement of cisterns on repeat CT. Conclusions: Mortality following head injury is high. Pre-hospital emergency medical services are disorganized. The key to reducing mortality within the limitations of our current trauma system is maintenance of DBP>70 mmHg and SBP> 90 mmHg from the time of first contact.
The Effects of Intracranial Pressure Monitoring in Patients with Traumatic Brain Injury  [PDF]
Shao-Hua Su, Fei Wang, Jian Hai, Ning-Tao Liu, Fei Yu, Yi-Fang Wu, You-Hou Zhu
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0087432
Abstract: Background Although international guideline recommended routine intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury(TBI), there were conflicting outcomes attributable to ICP monitoring according to the published studies. Hence, we conducted a meta-analysis to evaluate the efficacy and safety of ICP monitoring in patients with TBI. Methods Based on previous reviews, PubMed and two Chinese databases (Wangfang and VIP) were further searched to identify eligible studies. The primary outcome was mortality. Secondary outcomes included unfavourable outcome, adverse events, length of ICU stay and length of hospital stay. Weighted mean difference (WMD), odds ratio (OR) and 95% confidence intervals (CIs) were calculated and pooled using fixed-effects or random-effects model. Results two randomized controlled trials (RCTs) and seven cohort studies involving 11,038 patients met the inclusion criteria. ICP monitoring was not associated with a significant reduction in mortality (OR, 1.16; 95% CI, 0.87–1.54), with substantial heterogeneity (I2 = 80%, P<0.00001), which was verified by the sensitivity analyses. No significant difference was found in the occurrence of unfavourable outcome (OR, 1.40; 95% CI, 0.99–1.98; I2 = 4%, P = 0.35) and advese events (OR, 1.04; 95% CI, 0.64–1.70; I2 = 78%, P = 0.03). However, we should be cautious to the result of adverse events because of the substantial heterogeneity in the comparison. Furthermore, longer ICU and hospital stay were the consistent tendency according to the pooled studies. Conclusions No benefit was found in patients with TBI who underwent ICP monitoring. Considering substantial clinical heterogeneity, further large sample size RCTs are needed to confirm the current findings.
Dialysis disequilibrium syndrome in neurointensive care unit: the benefit of intracranial pressure monitoring
Pierre Esnault, Guillaume Lacroix, Pierre-Julien Cungi, Erwan D'Aranda, Jean Cotte, Philippe Goutorbe
Critical Care , 2012, DOI: 10.1186/cc11877
Abstract: A 51-year-old man was admitted for severe traumatic brain injury. At admission, an extradural hematoma was evacuated. After surgery, ICP monitoring guided the treatment. At day 4, toxic acute renal failure appeared. Fearing the occurrence of a DDS, we used continuous veno-venous hemofiltration (CVVH), which allowed a gradual reduction in urea without an intracranial hypertension (ICH) episode. Later, after a resumption of diuresis, we stopped CVVH. At day 11, urea increased to 35.6 mmol/L and creatininemia to 452 μmol/L. Serum sodium was 145 mmol/L. Because the trauma had occurred several days before, we decided to perform HD. One hour after the start of HD, an ICH appeared (ICP = 37 mm Hg). Urea was 22.3 mmol/L and serum sodium was 144 mmol/L (unchanged). DDS was diagnosed. After HD was stopped, osmotherapy was administered, and neurosedation was increased, ICP returned to normal (Figure 1). Afterward, we successfully used CVVH without a new episode of ICH. At day 19, the patient was discharged and later made a full recovery.DDS was first described in 1962 [2]. Symptoms due to cerebral edema vary from headache, nausea, and convulsion to coma. In our case, we detect DDS by ICP monitoring. Risk factors are first HD, severe uremia, age, pre-existing neurological disorders, and metabolic acidosis. A rapid clearing of small-sized molecules (such as urea) generated the symptoms. The main theory is the 'reverse urea effect', in which the shift of urea between brain intracellular space and plasma is not immediate but causes a brain intracellular space to interstitial osmotic gradient and leads to cerebral edema [3].This case is didactic because, as we monitored the ICP, we saw the consequences of DDS on the brain. Treatments consist of a slow gentle start of HD, increasing dialysate sodium levels, and administration of osmotically active substances. We think that CVVH should be used to treat patients with risk factors, especially in the neurointensive care unit [4]. This t
Third ventriculostomy through the lamina terminalis for intracranial pressure monitoring after aneurysm surgery: technical note
Kraemer, Jorge L.;Gobbato, Pedro L.;Andrade-Souza, Yuri M.;
Arquivos de Neuro-Psiquiatria , 2002, DOI: 10.1590/S0004-282X2002000600009
Abstract: objective: a new ventriculostomy technique through the lamina terminalis is described. this technique is applied mainly during aneurysm surgery at the acute stage. method: thirteen patients were operated on intracranial aneurysms and, during the procedure, had the lamina terminalis fenestrated. a ventricular catheter was inserted into the third ventricule, left in place and connected to an external drainage system for further intracranial pressure (icp) monitoring and/or cerebrospinal fluid (csf) drainage. results: icp readings and csf drainage were obtained in all cases. no complication was recorded. conclusion: third ventriculostomy through the lamina terminalis is a simple and easy technique that can be used as an alternative to conventional ventriculostomy. this procedure can be indicated in cases where the ventricule is not reached by means of another technique, and when the decision to perform ventriculostomy is made at the end of aneurysm surgery.
Third ventriculostomy through the lamina terminalis for intracranial pressure monitoring after aneurysm surgery: technical note
Kraemer Jorge L.,Gobbato Pedro L.,Andrade-Souza Yuri M.
Arquivos de Neuro-Psiquiatria , 2002,
Abstract: OBJECTIVE: A new ventriculostomy technique through the lamina terminalis is described. This technique is applied mainly during aneurysm surgery at the acute stage. METHOD: Thirteen patients were operated on intracranial aneurysms and, during the procedure, had the lamina terminalis fenestrated. A ventricular catheter was inserted into the third ventricule, left in place and connected to an external drainage system for further intracranial pressure (ICP) monitoring and/or cerebrospinal fluid (CSF) drainage. RESULTS: ICP readings and CSF drainage were obtained in all cases. No complication was recorded. CONCLUSION: Third ventriculostomy through the lamina terminalis is a simple and easy technique that can be used as an alternative to conventional ventriculostomy. This procedure can be indicated in cases where the ventricule is not reached by means of another technique, and when the decision to perform ventriculostomy is made at the end of aneurysm surgery.
Clinical application of invasive intracranial pressure monitoring after severe traumatic brain injury  [cached]
Xia LI,Bing LI,Li YANG,Wei LIN
Medical Journal of Chinese People's Liberation Army , 2011,
Abstract: Objective The current study aims to investigate the effects of different intracranial pressure(ICP) monitoring means on the prognosis of severe traumatic brain injury,and to determine the significance of all kinds of intracranial pressure monitoring methods for treating severe traumatic brain injury clinically.Methods From January 2009 to June 2010,a total of 201 cases of severe traumatic brain injury(STBI) who received operation treatment were collected and divided into A,B,and C groups based on the positions of the ICP probes and the placement methods.ICP monitoring probes were placed in the ventricle of the brain,parenchyma,or under the putamen,on the basis of the routine operation.Lumbar puncture was done once a day for three to seven days after operation.The Ncurolymph pressure and ICP value that are simultaneously shown in the ICP monitoring device were recorded to calculate the difference between them and to conduct comparison among the groups.The corresponding dehydration treatment was made based on the ICP value after operation to record the duration of use and dosage of the dehydrating agent,operation time,occurrence of all kinds of complications,and the prognosis of patients,and to create a comparison among the groups.Results The different values between the ICP monitoring values and ncurolymph pressure in the A,B,and C groups were 22.4±3.6,20.8±4.1,and 12.3±11.5 mmH2O,respectively. The dosage and durationof use of mannitol in group C were significantly higher than those in groups A and B(P < 0.01),whereas the incidence of pulmonary infection and electrolyte disturbance in group C was higher than those in groups A and B(P < 0.01).However,no significant difference of prognosis was observed among the three groups.The operating duration of group A was significantly longer than those of groups B and C(P < 0.01).However,the overall prognosis of the patients in the three groups had no significant difference.The operation time of group A was longer than that of groups B and C(P < 0.01),whereas the operation time of groups B and C had no significant difference.Conclusion The ICP value obtained through continuous invasive ICP monitoring is more stable,which makes it an important means for treating STBI.In addition,placing probes in the parenchyma is an effective monitoring method.
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