Combined monitoring of intracranial pressure and bispectral index in patients with severe craniocerebral trauma post-operatively

Correlation between bispectral index and prognosis of patients with acute cerebral infarction

INTRODUCTION

This study aimed to investigate the clinical value of bispectral index (BIS) monitoring in assessing the consciousness and prognosis of acute cerebral infarction (ACI) patients.

METHODS

In total, 64 patients who suffered from ACI with consciousness disturbance were enrolled in this study. Glasgow Coma Scale (GCS) was performed to evaluate the consciousness level of ACI patients, and BIS was used to monitor the depth of anesthesia and sedation. Then, patients were divided into good prognosis, poor prognosis and death groups according to modified Rankin score (mRS). Discrimination analysis of BIS values and GCS score for the prediction of prognosis was performed using the receiver operator characteristic (ROC) curve.

RESULTS

GCS score and BIS values showed statistically significant differences among the three groups. Spearman rank correlation analysis revealed a significant positive correlation between BIS values and GCS score, while BIS values was negatively related with mRS. The ROC curve of prognosis prediction showed strong prognostic power, with area under the curves (AUCs) between 0.830 and 0.917. Moreover, the AUC of BISmean score was higher than that of BISmax, BISmin and GCS, and BISmean of 74 was the best cut-off point for good prognosis.

CONCLUSION

BIS directly reflects the degree of consciousness disturbance in ACI patients, and thus accurately predicts the prognosis, indicating potential application values of BIS in clinical practice.

Evaluation of Prognosis of Coma Patients With Acute Brain Injury by Electroencephalogram Bispectral Index Monitoring

BACKGROUND

The high mortality rate of comatose patients with traumatic brain injury is a prominent public health issue that negatively impacts patients and their families. Objective, reliable tools are needed to guide treatment decisions and prioritize resources.

OBJECTIVE

This study aimed to evaluate the prognostic value of the bispectral index (BIS) in comatose patients with severe brain injury.

METHODS

This was a retrospective cohort study of 84 patients with severe brain injury and Glasgow Coma Scale (GCS) scores of 8 and less treated from January 2015 to June 2017. Sedatives were withheld at least 24 hr before BIS scoring. The BIS value, GCS scores, and Full Outline of UnResponsiveness (FOUR) were monitored hourly for 48 hr. Based on the Glasgow Outcome Scale (GOS) score, the patients were divided into poor (GOS score: 1-2) and good prognosis groups (GOS score: 3-5). The correlation between BIS and prognosis was analyzed by logistic regression, and the receiver operating characteristic curves were plotted.

RESULTS

The mean (SD) of the BIS value: 54.63 (11.76), p = .000; and GCS score: 5.76 (1.87), p = .000, were higher in the good prognosis group than in the poor prognosis group. Lower BIS values and GCS scores were correlated with poorer prognosis. Based on the area under the curve of receiver operating characteristic curves, the optimal diagnostic cutoff value of the BIS was 43.6, and the associated sensitivity and specificity were 85.4% and 74.4%, respectively.

CONCLUSION

Taken together, our study indicates that BIS had good predictive value on prognosis. These findings suggested that BIS could be used to evaluate the severity and prognosis of severe brain injury.

Value of Ventricular Intracranial Pressure Monitoring for Traumatic Bifrontal Contusions

OBJECTIVE

To investigate clinical efficacy of and optimal therapeutic strategy for ventricular intracranial pressure monitoring (V-ICPM) in patients with traumatic bifrontal contusions (TBCs).

METHODS

From 8760 patients with traumatic brain injury treated between January 2010 and January 2016, a retrospective analysis was performed on 105 patients with TBCs who underwent V-ICPM and 282 patients with TBCs who did not. All patients underwent treatment at the 101st Hospital of PLA, Wuxi, China. Rates of successful conservative treatment, decompressive craniectomy, and bifrontal craniotomy; incidence of neurologic dysfunction; length of stay; and medical expenses were compared between groups.

RESULTS

Glasgow Outcome Scale was used to assess all patients during follow-up (range, 6 months to 5.5 years). There were no significant differences in prognosis between the 2 groups (P = 0.100). Compared with the patients who did not undergo V-ICPM, the V-ICPM group had a significantly better successful conservative treatment rate (64.8% vs. 47.2%, P = 0.002), decompressive craniectomy rate (8.1% vs. 22.1%, P = 0.008), and bifrontal craniotomy rate (5.7% vs. 15.6%, P = 0.01); shorter length of stay (P = 0.000); and lower medical expenses (P = 0.004).

CONCLUSIONS

Patients with TBCs should be strictly, closely, and dynamically observed by neurosurgery intensive care unit physicians and nurses. Patients should undergo ventricular intracranial pressure probe implantation in a timely manner. V-ICPM can help optimize treatment. Although V-ICPM did not significantly improve the prognosis of patients, it had many other advantages. V-ICPM warrants further clinical research and may be beneficial for patients with TBCs.