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Qu M, Xu Y, Lu L. Global research evolution and frontier analysis of artificial intelligence in brain injury: A bibliometric analysis. Brain Res Bull 2024; 209:110920. [PMID: 38453035 DOI: 10.1016/j.brainresbull.2024.110920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/18/2023] [Accepted: 03/03/2024] [Indexed: 03/09/2024]
Abstract
Research on artificial intelligence for brain injury is currently a prominent area of scientific research. A significant amount of related literature has been accumulated in this field. This study aims to identify hotspots and clarify research resources by conducting literature metrology visualization analysis, providing valuable ideas and references for related fields. The research object of this paper consists of 3000 articles cited in the core database of Web of Science from 1998 to 2023. These articles are visualized and analyzed using VOSviewer and CiteSpace. The bibliometric analysis reveals a continuous increase in the number of articles published on this topic, particularly since 2016, indicating significant growth. The United States stands out as the leading country in artificial intelligence for brain injury, followed by China, which tends to catch up. The core research institutions are primarily universities in developed countries, but there is a lack of cooperation and communication between research groups. With the development of computer technology, the research in this field has shown strong wave characteristics, experiencing the early stage of applied research based on expert systems, the middle stage of prediction research based on machine learning, and the current phase of diversified research focused on deep learning. Artificial intelligence has innovative development prospects in brain injury, providing a new orientation for the treatment and auxiliary diagnosis in this field.
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Affiliation(s)
- Mengqi Qu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China.
| | - Yang Xu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China.
| | - Lu Lu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China.
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Waack AL, Lucarelli V, Leverich M, Ren G, Schroeder JL, Hoyt AT. Patterns and outcomes of intracranial pressure monitoring in traumatic brain injury: An analysis of the National Inpatient Sample. Clin Neurol Neurosurg 2024; 238:108168. [PMID: 38382131 DOI: 10.1016/j.clineuro.2024.108168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Elevated intracranial pressure (ICP) can cause progressive neurological deterioration following traumatic brain injury (TBI). ICP can be monitored to guide subsequent treatment decisions. However, there is conflicting data in the literature regarding the utility of ICP monitoring. We aim to describe patterns and outcomes of ICP monitoring in the United States with the use of a nationwide healthcare database. METHODS We performed a 5-year analysis of the Nationwide Inpatient Sample database. We identified all adult TBI patients with a Glasgow Coma Scale (GCS) measuring 3-8 using International Classification of Diseases diagnostic codes. Propensity score matching (1:2 ratio) was performed to control for demographics, injury parameters and comorbidities. Outcome measures included inpatient mortality, length of stay (LOS), cost of care, and discharge disposition. RESULTS After propensity score matching, a cohort of 1664 patients was obtained (monitored, 555; non-monitored, 1109). Index outcomes with respect to monitor and no-monitor are as follows: inpatient mortality (35.1%, 42.4%, P <0.01), median LOS (15 days, 6 days, P<0.001), median total charge (289,797 USD, 154,223 USD, P <0.001), discharge home (7.9%, 19.3%, P <0.001) and discharge to another facility (53.9%, 35.4%, P <0.001). DISCUSSION ICP monitoring in TBI patients is associated with decreased inpatient mortality and discharge to home, and it is associated with an increased hospital LOS, total charge, and chance of discharge to another facility. CONCLUSION The risks and benefits of ICP monitoring should be seriously considered when managing adults with severe TBI.
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Affiliation(s)
- Andrew L Waack
- Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Ave., Toledo, OH 43614, United States.
| | - Vito Lucarelli
- Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Ave., Toledo, OH 43614, United States
| | - Matthew Leverich
- Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Ave., Toledo, OH 43614, United States
| | - Gang Ren
- Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Ave., Toledo, OH 43614, United States
| | - Jason L Schroeder
- Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Ave., Toledo, OH 43614, United States; ProMedica Physicians Neurosurgery, 2130 W Central Ave., Suite 105, Toledo, OH 43606, United States
| | - Alastair T Hoyt
- Department of Surgery, Division of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Ave., Toledo, OH 43614, United States
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Chesnut RM, Temkin N, Videtta W, Lujan S, Petroni G, Pridgeon J, Dikmen S, Chaddock K, Hendrix T, Barber J, Machamer J, Guadagnoli N, Hendrickson P, Alanis V, La Fuente G, Lavadenz A, Merida R, Sandi Lora F, Romero R, Pinillos O, Urbina Z, Figueroa J, Ochoa M, Davila R, Mora J, Bustamante L, Perez C, Leiva J, Carricondo C, Mazzola AM, Guerra J. The Roles of Protocols and Protocolization in Improving Outcome From Severe Traumatic Brain Injury. Neurosurgery 2023:00006123-990000000-00986. [PMID: 38051042 DOI: 10.1227/neu.0000000000002777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/02/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Our Phase-I parallel-cohort study suggested that managing severe traumatic brain injury (sTBI) in the absence of intracranial pressure (ICP) monitoring using an ad hoc Imaging and Clinical Examination (ICE) treatment protocol was associated with superior outcome vs nonprotocolized management but could not differentiate the influence of protocolization from that of the specific protocol. Phase II investigates whether adopting the Consensus REVised Imaging and Clinical Examination (CREVICE) protocol improved outcome directly or indirectly via protocolization. METHODS We performed a Phase-II sequential parallel-cohort study examining adoption of the CREVICE protocol from no protocol vs a previous protocol in patients with sTBI older than 13 years presenting ≤24 hours after injury. Primary outcome was prespecified 6-month recovery. The study was done mostly at public South American centers managing sTBI without ICP monitoring. Fourteen Phase-I nonprotocol centers and 5 Phase-I protocol centers adopted CREVICE. Data were analyzed using generalized estimating equation regression adjusting for demographic imbalances. RESULTS A total of 501 patients (86% male, mean age 35.4 years) enrolled; 81% had 6 months of follow-up. Adopting CREVICE from no protocol was associated with significantly superior results for overall 6-month extended Glasgow Outcome Score (GOSE) (protocol effect = 0.53 [0.11, 0.95], P = .013), mortality (36% vs 21%, HR = 0.59 [0.46, 0.76], P < .001), and orientation (Galveston Orientation and Amnesia Test discharge protocol effect = 10.9 [6.0, 15.8], P < .001, 6-month protocol effect = 11.4 [4.1, 18.6], P < .005). Adopting CREVICE from ICE was associated with significant benefits to GOSE (protocol effect = 0.51 [0.04, 0.98], P = .033), 6-month mortality (25% vs 18%, HR = 0.55 [0.39, 0.77], P < .001), and orientation (Galveston Orientation and Amnesia Test 6-month protocol effect = 9.2 [3.6, 14.7], P = .004). Comparing both groups using CREVICE, those who had used ICE previously had significantly better GOSE (protocol effect = 1.15 [0.09, 2.20], P = .033). CONCLUSION Centers managing adult sTBI without ICP monitoring should strongly consider protocolization through adopting/adapting the CREVICE protocol. Protocolization is indirectly supported at sTBI centers regardless of resource availability.
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Affiliation(s)
- Randall M Chesnut
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Department of Orthopaedic Surgery, University of Washington, Seattle, Washington, USA
- School of Global Health, University of Washington, Seattle, Washington, USA
- Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Walter Videtta
- Terapia Intensiva, Hospital Nacional Professor Alejandro Posadas, Buenos Aires, Argentina
| | - Silvia Lujan
- Hospital Emergencia, Dr Clemente Alvarez, Rosario, Argentina
- Centro de Informatica e Investigacion Clinica, Rosario, Argentina
| | - Gustavo Petroni
- School of Global Health, University of Washington, Seattle, Washington, USA
| | - Jim Pridgeon
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Kelley Chaddock
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Joan Machamer
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Nahuel Guadagnoli
- Hospital Emergencia, Dr Clemente Alvarez, Rosario, Argentina
- Centro de Informatica e Investigacion Clinica, Rosario, Argentina
| | - Peter Hendrickson
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Victor Alanis
- Terapia Intensiva, Hospital San Juan de Dios, Santa Cruz de la Sierra, Bolivia
| | - Gustavo La Fuente
- Terapia Intensiva, Hospital Japones, Santa Cruz de la Sierra, Bolivia
| | | | - Roberto Merida
- Terapia Intensiva, Hospital San Juan de Dios, Tarija, Bolivia
| | | | - Ricardo Romero
- Terapia Intensiva, Fundacion Clinica Campbell, Barranquilla, Colombia
| | - Oscar Pinillos
- Terapia Intensiva, Clinica Universitaria Rafael Uribe, Cali, Colombia
| | - Zulma Urbina
- Terapia Intensiva, Hospital Erasmo Meoz ICU No 1, Cucuta, Colombia
| | - Jairo Figueroa
- Terapia Intensiva, Hospital Erasmo Meoz ICU No 2, Cucuta, Colombia
| | - Marcelo Ochoa
- Terapia Intensiva, Hospital José Carrasco Artega, Cuenca, Ecuador
| | - Rafael Davila
- Terapia Intensiva, Hospital Luis Razetti, Barinas, Venezuela
| | - Jacobo Mora
- Terapia Intensiva, Hospital Luis Razetti, Barcelona, Venezuela
| | - Luis Bustamante
- Terapia Intensiva, Delicia Conception Hospital Masvernat, Concordia, Entre Ríos, Argentina
| | - Carlos Perez
- Terapia Intensiva, Hospital Justo José de Urquiza, Concepción del Uruguay, Entre Ríos, Argentina
| | - Jorge Leiva
- Terapia Intensiva, Hospital Córdoba, Córdoba, Argentina
| | | | | | - Juan Guerra
- Terapia Intensiva, Hospital COSSMIL Militar, Louisiana Paz, Bolivia
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Lee Y, Lee JH, Choi HJ, Kim BC, Yu S, Ha M. Current Status of Intracranial Pressure Monitoring in Patients with Severe Traumatic Brain Injury in Korea : A Post Hoc Analysis of Korea Neurotrauma Databank Project with a Nationwide Survey. J Korean Neurosurg Soc 2023; 66:543-551. [PMID: 37016766 PMCID: PMC10483167 DOI: 10.3340/jkns.2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the current status of intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (sTBI) in Korea and the association between ICP monitoring and prognosis. In addition, a survey was administered to Korean neurosurgeons to investigate the perception of ICP monitoring in patients with sTBI. METHODS This study used data from the second Korea Neurotrauma Databank. Among the enrolled patients with sTBI, the following available clinical data were analyzed in 912 patients : Glasgow coma scale score on admission, ICP monitoring, mortality, and extended Glasgow outcome scale score at 6 months. In addition, we administered a survey, entitled "current status and perception of ICP monitoring in Korean patients with sTBI" to 399 neurosurgeons who were interested in traumatic brain injury. RESULTS Among the 912 patients, 79 patients (8.7%) underwent ICP monitoring. The mortality and favorable outcome were compared between the groups with and without ICP monitoring, and no statistically significant results were found. Regarding the survey, there were 61 respondents. Among them, 70.4% of neurosurgeons responded negatively to performing ICP monitoring after craniectomy/craniotomy, while 96.7% of neurosurgeons responded negatively to performing ICP monitoring when craniectomy/ craniotomy was not conducted. The reasons why ICP monitoring was not performed were investigated, and most respondents answered that there were no actual guidelines or experiences with post-operative ICP monitoring for craniectomy/craniotomy. However, in cases wherein craniectomy/craniotomy was not performed, most respondents answered that ICP monitoring was not helpful, as other signs were comparatively more important. CONCLUSION The proportion of performing ICP monitoring in patients with sTBI was low in Korea. The outcome and mortality were compared between the patient groups with and without ICP monitoring, and no statistically significant differences were noted in prognosis between these groups. Further, the survey showed that ICP monitoring in patients with sTBI was somewhat negatively recognized in Korea.
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Affiliation(s)
- Youngheon Lee
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jung Hwan Lee
- Department of Neurosurgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk Jin Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung Chul Kim
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Seunghan Yu
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Mahnjeong Ha
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Ghanem G, Haase D, Brzezinski A, Ogawa R, Asachi P, Chiem A. Ultrasound detected increase in optic disk height to identify elevated intracranial pressure: a systematic review. Ultrasound J 2023; 15:26. [PMID: 37227512 DOI: 10.1186/s13089-023-00324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 04/27/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Elevated intracranial pressure (eICP) is a serious medical emergency that requires prompt identification and monitoring. The current gold standards of eICP detection require patient transportation, radiation, and can be invasive. Ocular ultrasound has emerged as a rapid, non-invasive, bedside tool to measure correlates of eICP. This systematic review seeks to explore the utility of ultrasound detected optic disc elevation (ODE) as an ultrasonographic finding of eICP and to study its sensitivity and specificity as a marker of eICP. METHODS This systematic review followed the preferred reporting items for systematic reviews and meta-analyses guidelines. We systematically searched PubMed, EMBASE, and Cochrane Central for English articles published before April 2023; yielding 1,919 total citations. After eliminating duplicates, and screening the records, we identified 29 articles that addressed ultrasonographically detected ODE. RESULTS The 29 articles included a total of 1249 adult and pediatric participants. In patients with papilledema, the mean ODE ranged between 0.6 mm and 1.2 mm. Proposed cutoff values for ODE ranged between 0.3 mm and 1 mm. The majority of studies reported a sensitivity between 70 and 90%, and specificity ranged from 69 to 100%, with a majority of studies reporting a specificity of 100%. CONCLUSIONS ODE and ultrasonographic characteristics of the optic disc may aid in differentiating papilledema from other conditions. Further research on ODE elevation and its correlation with other ultrasonographic signs is warranted as a means to increase the diagnostic accuracy of ultrasound in the setting of eICP.
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Affiliation(s)
- Ghadi Ghanem
- David Geffen School of Medicine, University of California, Los Angeles, USA.
| | - David Haase
- Department of Emergency Medicine, David Geffen School of Medicine UCLA, Olive View UCLA Medical Center, Los Angeles, USA
| | - Agatha Brzezinski
- Department of Emergency Medicine, David Geffen School of Medicine UCLA, Olive View UCLA Medical Center, Los Angeles, USA
| | - Rikke Ogawa
- UCI Libraries, University of California, Irvine, USA
| | - Parsa Asachi
- David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Alan Chiem
- Department of Emergency Medicine, David Geffen School of Medicine UCLA, Olive View UCLA Medical Center, Los Angeles, USA
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Chesnut RM, Temkin N, Videtta W, Lujan S, Petroni G, Pridgeon J, Dikmen S, Chaddock K, Hendrix T, Barber J, Machamer J, Guadagnoli N, Hendrickson P, Alanis V, La Fuente G, Lavadenz A, Merida R, Lora FS, Romero R, Pinillos O, Urbina Z, Figueroa J, Ochoa M, Davila R, Mora J, Bustamante L, Perez C, Leiva J, Carricondo C, Mazzola AM, Guerra J. Testing the Impact of Protocolized Care of Patients With Severe Traumatic Brain Injury Without Intracranial Pressure Monitoring: The Imaging and Clinical Examination Protocol. Neurosurgery 2023; 92:472-480. [PMID: 36790211 PMCID: PMC10158870 DOI: 10.1227/neu.0000000000002251] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/30/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Most patients with severe traumatic brain injury (sTBI) in low- or-middle-income countries and surprisingly many in high-income countries are managed without intracranial pressure (ICP) monitoring. The impact of the first published protocol (Imaging and Clinical Examination [ICE] protocol) is untested against nonprotocol management. OBJECTIVE To determine whether patients treated in intensive care units (ICUs) using the ICE protocol have lower mortality and better neurobehavioral functioning than those treated in ICUs using no protocol. METHODS This study involved nineteen mostly public South American hospitals. This is a prospective cohort study, enrolling patients older than 13 years with sTBI presenting within 24 h of injury (January 2014-July 2015) with 6-mo postinjury follow-up. Five hospitals treated all sTBI cases using the ICE protocol; 14 used no protocol. Primary outcome was prespecified composite of mortality, orientation, functional outcome, and neuropsychological measures. RESULTS A total of 414 patients (89% male, mean age 34.8 years) enrolled; 81% had 6 months of follow-up. All participants included in composite outcome analysis: average percentile (SD) = 46.8 (24.0) nonprotocol, 56.9 (24.5) protocol. Generalized estimating equation (GEE) used to account for center effects (confounder-adjusted difference [95% CI] = 12.2 [4.6, 19.8], P = .002). Kaplan-Meier 6-month mortality (95% CI) = 36% (30%, 43%) nonprotocol, 25% (19%, 31%) protocol (GEE and confounder-adjusted hazard ratio [95% CI] = .69 [.43, 1.10], P = .118). Six-month Extended Glasgow Outcome Scale for 332 participants: average Extended Glasgow Outcome Scale score (SD) = 3.6 (2.6) nonprotocol, 4.7 (2.8) protocol (GEE and confounder-adjusted and lost to follow-up-adjusted difference [95% CI] = 1.36 [.55, 2.17], P = .001). CONCLUSION ICUs managing patients with sTBI using the ICE protocol had better functional outcome than those not using a protocol. ICUs treating patients with sTBI without ICP monitoring should consider protocolization. The ICE protocol, tested here and previously, is 1 option.
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Affiliation(s)
- Randall M. Chesnut
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Nancy Temkin
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Walter Videtta
- Medicina Intensiva, Hospital Nacional Professor Alejandro Posadas, Buenos Aires, Argentina;
| | - Silvia Lujan
- Hospital Emergencia, Dr Clemente Alvarez, Rosario, Argentina;
| | - Gustavo Petroni
- Hospital Emergencia, Dr Clemente Alvarez, Rosario, Argentina;
| | - Jim Pridgeon
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Sureyya Dikmen
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Kelley Chaddock
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | | | - Jason Barber
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Joan Machamer
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | | | - Peter Hendrickson
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Victor Alanis
- Medicina Intensiva, Hospital San Juan de Dios, Santa Cruz de la Sierra, Bolivia;
| | - Gustavo La Fuente
- Medicina Intensiva, Hospital Japones, Santa Cruz de la Sierra, Bolivia;
| | | | - Roberto Merida
- Medicina Intensiva, Hospital San Juan de Dios, Tarija, Bolivia;
| | | | - Ricardo Romero
- Medicina Intensiva, Fundacion Clinica Campbell, Barranquilla, Colombia;
| | - Oscar Pinillos
- Medicina Intensiva, Clinica Universitaria Rafael Uribe, Cali, Colombia;
| | - Zulma Urbina
- Medicina Intensiva, Hospital Erasmo Meoz ICU No 1, Cucuta, Colombia;
| | - Jairo Figueroa
- Medicina Intensiva, Hospital Erasmo Meoz ICU No 2, Cucuta, Colombia;
| | - Marcelo Ochoa
- Medicina Intensiva, Hospital José Carrasco Artega, Cuenca, Ecuador;
| | - Rafael Davila
- Medicina Intensiva, Hospital Luis Razetti, Barinas, Venezuela;
| | - Jacobo Mora
- Medicina Intensiva, Hospital Luis Razetti, Barcelona, Venezuela;
| | - Luis Bustamante
- Medicina Intensiva, Delicia Conception Hospital Masvernat, Concordia, Entre Ríos, Argentina;
| | - Carlos Perez
- Medicina Intensiva, Hospital Justo José de Urquiza, Concepción del Uruguay, Entre Ríos, Argentina;
| | - Jorge Leiva
- Medicina Intensiva, Hospital Córdoba, Córdoba, Argentina;
| | | | - Ana Maria Mazzola
- Medicina Intensiva, Hospital San Felipe, San Nicolás, Buenos Aires, Argentina;
| | - Juan Guerra
- Medicina Intensiva, Hospital COSSMIL Militar, La Paz, Bolivia
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Foote CW, Jarvis S, Doan XL, Guice J, Cruz B, Vanier C, Betancourt A, Bar-Or D, Palacio CH. Correlation between intracranial pressure monitoring for severe traumatic brain injury with hospital length of stay and discharge disposition: a retrospective observational cohort study. Patient Saf Surg 2022; 16:40. [PMID: 36581936 PMCID: PMC9801642 DOI: 10.1186/s13037-022-00350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Intracranial pressure (ICP) monitoring is recommended for severe traumatic brain injuries (TBI) but some data suggests it may not improve outcomes. The objective was to investigate the effect of ICP monitoring among TBI. METHODS This retrospective observational cohort study (1/1/2015-6/1/2020) included severe TBI patients. Outcomes [discharge destination, length of stay (LOS)] were compared by ICP monitoring and were stratified by GCS (3 vs. 4-8), α < 0.05. RESULTS Of the123 patients who met inclusion criteria, 47% received ICP monitoring. There were baseline differences in the two groups characteristics, ICP monitored patients were younger (p = 0.02), had a subarachnoid hemorrhage less often (p = 0.04), and a subdural hematoma more often (p = 0.04) than those without ICP monitors. ICP monitored patients had a significantly longer median LOS (12 vs. 3, p < 0.01) than patients without monitoring. There was a trend towards more ICP monitored patients discharged home (40% vs. 23%, p = 0.06). Among patients with GCS = 3, ICP monitored patients had a longer LOS (p < 0.01) with no significant differences in discharge destinations. For those with a GCS of 4-8, ICP monitoring was associated with a longer LOS (p = 0.01), but fewer were discharged to a skilled nursing facility or long-term care (p = 0.01). CONCLUSIONS For TBI patients, ICP monitoring was associated with an increased LOS, with no significant differences in discharge destinations when compared to those without ICP monitoring. However, among only those with a GCS of 4-8, ICP monitoring was associated with a decreased proportion of patients discharged to a skilled nursing facility or long-term acute care .
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Affiliation(s)
- Christopher W. Foote
- McAllen Medical Center, South Texas Health System, 301 W Expy 83, McAllen, TX 78503 USA ,Valley Health Systems, Graduate Medical Education, 2075 East Flamingo Rd, Las Vegas, NV 89119 USA
| | - Stephanie Jarvis
- Injury Outcomes Network (ION) Research, 501 East Hampden Ave, Englewood, CO 80113 USA
| | - Xuan-Lan Doan
- McAllen Medical Center, South Texas Health System, 301 W Expy 83, McAllen, TX 78503 USA ,Valley Health Systems, Graduate Medical Education, 2075 East Flamingo Rd, Las Vegas, NV 89119 USA
| | - Jordan Guice
- grid.416653.30000 0004 0450 5663Brooke Army Medical Center, 8551 Roger Brooke Dr, San Antonio, TX 78219 USA
| | - Bianca Cruz
- McAllen Medical Center, South Texas Health System, 301 W Expy 83, McAllen, TX 78503 USA
| | - Cheryl Vanier
- grid.430773.40000 0000 8530 6973Touro University, School of Medicine, 874 American Pacific Dr, Henderson, NV 89014 USA
| | - Alejandro Betancourt
- McAllen Medical Center, South Texas Health System, 301 W Expy 83, McAllen, TX 78503 USA
| | - David Bar-Or
- Injury Outcomes Network (ION) Research, 501 East Hampden Ave, Englewood, CO 80113 USA
| | - Carlos H. Palacio
- McAllen Medical Center, South Texas Health System, 301 W Expy 83, McAllen, TX 78503 USA ,Valley Health Systems, Graduate Medical Education, 2075 East Flamingo Rd, Las Vegas, NV 89119 USA
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Han N, Yang F, Zhang X, Diwakar M. The Significance of Intracranial Pressure Monitoring for Reducing Mortality in Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Computational and Mathematical Methods in Medicine 2022; 2022:1-12. [PMID: 36254239 PMCID: PMC9569199 DOI: 10.1155/2022/1956908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
Background Despite guidelines provided by the Brain Trauma Foundation (BTF) for treating patients with TBI, including advice to monitor intracranial pressure (ICP), the clinical application of ICP monitoring is far from universal. This laxity has been attributed to the relationship between mortality in TBI patients and ICP monitoring. Objective This systematic review and meta-analysis was aimed at determining the effect of intracranial pressure (ICP) monitoring on the mortality of patients with traumatic brain injury (TBI). Method A systematic search for articles was conducted on PubMed, Scopus, Cochrane Central Register of Control Trials (CENTRAL), and APA PsycNet for articles published from 1 January 2000 to 1 August 2022. Manager 5.4 was used to carry out statistical analysis. Results Article search yielded 1421 articles, but only 23 cohort studies were included in the systematic review and meta-analysis. The total number of study participants is 80,058. Seventeen studies reported unadjusted odds ratios (OR), and only 8 reported the adjusted odds ratio (OR). Nine out of seventeen studies reported an unadjusted OR of less than 1, and five out of eight studies reported an adjusted OR of less than 1. From this paper's analysis, the OR for in-hospital mortality was 1.01 [95% CI, 0.80, 1.28], with a p value of 0.92. OR for ICU mortality was 0.84 [95% CI, 0.52, 1.35], with a p value of 0.47. Conclusion But due to conflicting results, as evident above, it is unsatisfyingly challenging to draw any substantial conclusions from them. This paper thus calls for more research on this particular paper.
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Pastor IS, Dumbravă LP, Siserman C, Stan H, Para I, Florian IȘ. Predictive factors of 30-day mortality in patients with traumatic subdural hematoma. Exp Ther Med 2021; 22:757. [PMID: 34035854 DOI: 10.3892/etm.2021.10189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/19/2021] [Indexed: 11/05/2022] Open
Abstract
In the present study, we aimed to assess and analyze the predictive factors of 30-day mortality in patients with acute subdural hematoma (ASDH) who underwent surgical intervention after traumatic brain injury (TBI). We conducted a retrospective study, which included a cohort of 135 consecutive patients diagnosed with ASDH who required surgical evacuation. We assessed the demographic and clinical data, the imaging data of the hematoma described by preoperative computed tomography (CT) and the type of neurosurgical intervention for hematoma evacuation via either craniectomy or craniotomy. The patients were followed up for 30 days after head trauma and the occurrence of death was noted. Death was recorded in 63 (46.6%) patients at 30 days after TBI. There was a significant number of deceased patients who underwent craniectomy (71.4%). The Glasgow Coma Scale (GCS) was statistically significantly lower in patients who died (P<0.001), with a cut-off value of ≤12, under which the probability of death increased [AUC 0.830 (95% CI, 0.756-0.889); Se 90.48% (95% CI, 80.4-96.4); Sp 66.7% (95% CI, 54.6-77.3); P<0.001]. The midline shift was statistically significantly higher in deceased patients (P=0.005), with a cut-off value of >7 mm, over which the probability of death increased [AUC 0.637 (95% CI, 0.550-0.718); Se 38.1% (95% CI, 26.1-51.2); Sp 86.1% (95% CI, 75.9-93.1); P=0.003]. There were significantly more deceased patients with intracranial hypertension, brain herniation, brain swelling, intraparenchymal hematoma and cranial fracture. In multivariate analysis only a Glasgow score ≤12 and a midline shift >7 mm were independently linked to mortality. Brain herniation and intraparenchymal hematoma were associated with a higher probability of dying, but the statistical threshold was slightly exceeded. The type of neurosurgery performed for patients with ASDH was not an independent predictive factor for 30-day mortality. However, craniectomy was associated with a higher mortality in patients with ASDH.
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Affiliation(s)
- Iulia-Sevastiana Pastor
- Department of Neurosurgery, Faculty of Medicine, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Lăcrimioara Perju Dumbravă
- First Department of Neurology, Faculty of Medicine, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Costel Siserman
- Department of Legal Medicine, Faculty of Medicine, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Horațiu Stan
- Department of Neurosurgery, Faculty of Medicine, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ioana Para
- Department of Internal Medicine, Faculty of Medicine, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ioan Ștefan Florian
- Department of Neurosurgery, Faculty of Medicine, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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10
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Grevfors N, Lindblad C, Nelson DW, Svensson M, Thelin EP, Rubenson Wahlin R. Delayed Neurosurgical Intervention in Traumatic Brain Injury Patients Referred From Primary Hospitals Is Not Associated With an Unfavorable Outcome. Front Neurol 2021; 11:610192. [PMID: 33519689 PMCID: PMC7839281 DOI: 10.3389/fneur.2020.610192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/03/2020] [Indexed: 01/29/2023] Open
Abstract
Background: Secondary transports of patients suffering from traumatic brain injury (TBI) may result in a delayed management and neurosurgical intervention, which is potentially detrimental. The aim of this study was to study the effect of triaging and delayed transfers on outcome, specifically studying time to diagnostics and neurosurgical management. Methods: This was a retrospective observational cohort study of TBI patients in need of neurosurgical care, 15 years and older, in the Stockholm Region, Sweden, from 2008 throughout 2014. Data were collected from pre-hospital and in-hospital charts. Known TBI outcome predictors, including the protein biomarker of brain injury S100B, were used to assess injury severity. Characteristics and outcomes of direct trauma center (TC) and those of secondary transfers were evaluated and compared. Functional outcome, using the Glasgow Outcome Scale, was assessed in survivors at 6–12 months after trauma. Regression models, including propensity score balanced models, were used for endpoint assessment. Results: A total of n = 457 TBI patients were included; n = 320 (70%) patients were direct TC transfers, whereas n = 137 (30%) were secondary referrals. In all, n = 295 required neurosurgery for the first 24 h after trauma (about 75% of each subgroup). Direct TC transfers were more severely injured (median Glasgow Coma Scale 8 vs. 13) and more often suffered a high energy trauma (31 vs. 2.9%) than secondary referrals. Admission S100B was higher in the TC transfer group, though S100B levels 12–36 h after trauma were similar between cohorts. Direct or indirect TC transfer could be predicted using propensity scoring. The secondary referrals had a shorter distance to the primary hospital, but had later radiology and surgery than the TC group (all p < 0.001). In adjusted multivariable analyses with and without propensity matching, direct or secondary transfers were not found to be significantly related to outcome. Time from trauma to surgery did not affect outcome. Conclusions: TBI patients secondary transported to a TC had surgical intervention performed hours later, though this did not affect outcome, presumably demonstrating that accurate pre-hospital triaging was performed. This indicates that for selected patients, a wait-and-see approach with delayed neurosurgical intervention is not necessarily detrimental, but warrants further research.
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Affiliation(s)
- Niklas Grevfors
- Division of Perioperative Medicine and Intensive Care (PMI), Department of Anesthesiology, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Lindblad
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - David W Nelson
- Division of Perioperative Medicine and Intensive Care (PMI), Department of Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.,Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Svensson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Eric Peter Thelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecka Rubenson Wahlin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Anesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden.,Ambulance Medical Service in Stockholm (Ambulanssjukvården i Storstockholm AB), Stockholm, Sweden.,Academic EMS, Stockholm, Sweden
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11
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Hoffman H, Bunch KM, Furst T, Chin LS. Use of Intracranial Pressure Monitoring in Patients with Severe Traumatic Brain Injury. World Neurosurg 2020; 142:e385-e395. [PMID: 32668331 DOI: 10.1016/j.wneu.2020.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The Brain Trauma Foundation (BTF) recommends intracranial pressure (ICP) monitoring for all salvageable patients with an abnormal computed tomography (CT) scan and a Glasgow Coma Scale <9. Studies have shown that compliance with this recommendation is low. We sought to obtain contemporary national rates of ICP monitor placement in patients with severe traumatic brain injury (TBI). METHODS Patients from the National Trauma Data Bank from 2013 to 2017 who met BTF criteria for ICP monitoring were included. Placement of an intraparenchymal ICP monitor or an external ventricular drain was queried. Binary logistic regression was used to determine factors that influenced the placement of an ICP monitor. RESULTS A total of 21,374 patients with severe TBI and an abnormal CT scan were included in the study. An ICP monitor was placed in 6543 patients (30.6%). ICP monitor placement increased modestly from 28.6% in 2013 to 32.8% in 2017. The pooled odds of ICP monitor placement between 2014 and 2017 were not different from 2013 (odds ratio, 1.04; 95% confidence interval, 0.99-1.09), but the adjusted odds of ICP monitor placement in 2017 were significantly greater (odds ratio, 1.18; 95% confidence interval, 1.06-1.30). Treatment at a teaching hospital, subdural hematoma, multiple intracranial abnormalities on CT, and greater Injury Severity Score were associated with ICP monitor placement, whereas older age was negatively associated with ICP monitor placement. CONCLUSIONS The rate of ICP monitoring in patients with severe TBI who meet BTF criteria is low and increased only slightly from 2013 to 2017.
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Affiliation(s)
- Haydn Hoffman
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York, USA.
| | - Katherine M Bunch
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Taylor Furst
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Lawrence S Chin
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York, USA
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12
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Allen A, Grigorian A, Christian A, Schubl SD, Barrios C Jr, Lekawa M, Borazjani B, Joe V, Nahmias J. Intracranial pressure monitors associated with increased venous thromboembolism in severe traumatic brain injury. Eur J Trauma Emerg Surg 2021; 47:1483-90. [PMID: 32157341 DOI: 10.1007/s00068-020-01336-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 02/19/2020] [Indexed: 11/15/2022]
Abstract
Background Utilization of intracranial pressure monitors (ICPMs) has not been consistently shown to improve mortality in patients with severe traumatic brain injury (TBI). A single-center analysis concluded that venous thromboembolism (VTE) chemoprophylaxis (CP) posed no significant bleeding risk in patients following ICPM implementation; however, there is still debate about the optimal use and timing of CP in patients with ICPMs for fear of worsening intracranial hemorrhage. We hypothesized that ICPM use is associated with increased time to VTE CP and thus increased VTE in patients with severe TBI. Methods A retrospective analysis of the Trauma Quality Improvement Program (2010–2016) was performed to compare severe TBI patients with and without ICPMs. A multivariable logistic regression analysis was completed. Results From 35,673 patients with severe TBI, 12,487 (35%) had an ICPM. Those with ICPMs had a higher rate of VTE CP (64.3% vs. 49.4%, p < 0.001) but a longer median time to CP initiation (5 vs. 4 days, p < 0.001) as well as a longer hospital length of stay (LOS) (18 vs. 9 days, p < 0.001) compared to those without ICPMs. After adjusting for covariates, ICPM use was found to be associated with a higher risk of VTE (9.2% vs 4.3%, OR = 1.75, CI = 1.42–2.15, p < 0.001). Conclusions Compared to patients without ICPMs, those with ICPMs had a longer delay to initiation of CP leading to an increase in VTE. In addition, there was a nearly two-fold higher associated risk for VTE in patients with ICPMs even when controlling for known VTE risk factors. Improved adherence to initiation of CP in the setting of ICPMs may help decrease the associated risk of VTE with ICPMs.
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13
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Mader MM, Leidorf A, Hecker A, Heimann A, Mayr PSM, Kempski O, Alessandri B, Wöbker G. Evaluation of a New Multiparameter Brain Probe for Simultaneous Measurement of Brain Tissue Oxygenation, Cerebral Blood Flow, Intracranial Pressure, and Brain Temperature in a Porcine Model. Neurocrit Care 2019; 29:291-301. [PMID: 29949006 PMCID: PMC6208836 DOI: 10.1007/s12028-018-0541-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND A novel multiparameter brain sensor (MPBS) allows the simultaneous measurement of brain tissue oxygenation (ptiO2), cerebral blood flow (CBF), intracranial pressure (ICP), and brain temperature with a single catheter. This laboratory investigation evaluates the MPBS in an animal model in relation to established reference probes. METHODS The study group consisted of 17 juvenile male pigs. Four MPBS and four reference probes were implanted per pig and compared simultaneously. The measured parameters were challenged by standardized provocations such as hyperoxia, dobutamine, and norepinephrine application, hypercapnia and hypoxia in combination with and without a controlled cortical impact (CCI) injury. Mean values over 2 min were collected for predefined time points and were analyzed using Bland-Altman plots. RESULTS The protocol was successfully conducted in 15 pigs of which seven received CCI. ICP and ptiO2 were significantly influenced by the provocations. Subtraction of MPBS from reference values revealed a mean difference (limits of agreement) of 3.7 (- 20.5 to 27.9) mm Hg, - 2.9 (- 7.9 to 2.1) mm Hg, and 5.1 (- 134.7 to 145.0) % for ptiO2, ICP, and relative CBF, respectively. CONCLUSIONS The MPBS is a promising measurement tool for multiparameter neuromonitoring. The conducted study demonstrates the in vivo functionality of the probe. Comparison with standard probes revealed a deviation which is mostly analogous to other multiparameter devices. However, further evaluation of the device is necessary before it can reliably be used for clinical decision making.
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Affiliation(s)
- Marius M Mader
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany.,Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Leidorf
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Andreas Hecker
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Axel Heimann
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Petra S M Mayr
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Oliver Kempski
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Beat Alessandri
- Institute for Neurosurgical Pathophysiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Gabriele Wöbker
- HELIOS Universitätsklinikum Wuppertal, University Witten/Herdecke, 42283 , Wuppertal, Germany
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14
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Roux PL. Management of Head Trauma in the Neurocritical Care Unit. Neurocrit Care 2019. [DOI: 10.1017/9781107587908.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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15
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Glushakova OY, Glushakov AV, Yang L, Hayes RL, Valadka AB. Intracranial Pressure Monitoring in Experimental Traumatic Brain Injury: Implications for Clinical Management. J Neurotrauma 2019; 37:2401-2413. [PMID: 30595079 DOI: 10.1089/neu.2018.6145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) is often associated with long-term disability and chronic neurological sequelae. One common contributor to unfavorable outcomes is secondary brain injury, which is potentially treatable and preventable through appropriate management of patients in the neurosurgical intensive care unit. Intracranial pressure (ICP) is currently the predominant neurological-specific physiological parameter used to direct the care of severe TBI (sTBI) patients. However, recent clinical evidence has called into question the association of ICP monitoring with improved clinical outcome. The detailed cellular and molecular derangements associated with intracranial hypertension (IC-HTN) and their relationship to injury phenotype and neurological outcomes are not completely understood. Various animal models of TBI have been developed, but the clinical applicability of ICP monitoring in the pre-clinical setting has not been well-characterized. Linking basic mechanistic studies in translational TBI models with investigation of ICP monitoring that more faithfully replicates the clinical setting will provide clinical investigators with a more informed understanding of the pathophysiology of IC-HTN, thus facilitating development of improved therapies for sTBI patients.
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Affiliation(s)
- Olena Y Glushakova
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Likun Yang
- Department of Neurosurgery, The 101st Hospital of Chinese People's Liberation Army, Xuxi, Jiangsu, China
| | - Ronald L Hayes
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA.,Banyan Biomarkers, Inc., Alachua, Florida, USA
| | - Alex B Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
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16
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Hoffman H, Jalal MS, Chin LS. Effect of Hypernatremia on Outcomes After severe Traumatic Brain Injury: A Nationwide Inpatient Sample analysis. World Neurosurg 2018; 118:e880-6. [DOI: 10.1016/j.wneu.2018.07.089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 12/30/2022]
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17
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Lele A, Kannan N, Vavilala MS, Sharma D, Mossa-Basha M, Agyem K, Mock C, Pandey RM, Dash HH, Mahapatra A, Gupta D. Patients Who Benefit from Intracranial Pressure Monitoring without Cerebrospinal Fluid Drainage After Severe Traumatic Brain Injury. Neurosurgery 2018; 85:231-239. [DOI: 10.1093/neuros/nyy247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 07/11/2018] [Indexed: 12/11/2022] Open
Abstract
AbstractBACKGROUNDIndia has a high traumatic brain injury (TBI) burden and intracranial pressure monitoring (ICP) remains controversial but some patients may benefit.OBJECTIVETo examine the association between ICP monitor placement and outcomes, and identify Indian patients with severe TBI who benefit from ICP monitoringMETHODSWe conducted a secondary analysis of a prospective cohort study at a level 1 Indian trauma center. Patients over 18 yr with severe TBI (admission Glasgow coma scale score < 8) who received tracheal intubation for at-least 48 h were examined. Propensity-based analysis using inverse probability weighting approach was used to examine ICP monitor placement within 72 h of admission and outcomes. Outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) score at discharge, 3, 6, and 12 mo. Death, vegetative, or major impairment defined unfavorable outcome.RESULTSThe 200 patients averaged 36 [18 to 85] yr of age and average injury severity score of 31.4 [2 to 73]. ICP monitors were placed in 126 (63%) patients. Patients with ICP monitor placement experienced lower in-hospital mortality (adjusted relative risk [aRR]; 0.50 [0.29, 0.87]) than patients without ICP monitoring. However, there was no benefit at 3, 6, and 12 mo. With ICP monitor placement, absence of cerebral edema (aRR 0.54, 95% confidence interval 0.35-0.84), and absence of intraventricular hemorrhage (aRR 0.52, 95% confidence interval 0.33-0.82) were associated with reduced unfavorable outcomes.CONCLUSIONICP monitor placement without cerebrospinal fluid drainage within 72 h of admission was associated with reduced in-patient mortality. Patients with severe TBI but without cerebral edema and without intraventricular hemorrhage may benefit from ICP monitoring.
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Affiliation(s)
- Abhijit Lele
- Departments of Anesthesiology & Pain Medicine, University of Washington, Sea-ttle, Washington
- Harborview Injury Prevention and Research Center, Seatt-le, Washington
| | - Nithya Kannan
- Harborview Injury Prevention and Research Center, Seatt-le, Washington
| | - Monica S Vavilala
- Departments of Anesthesiology & Pain Medicine, University of Washington, Sea-ttle, Washington
- Harborview Injury Prevention and Research Center, Seatt-le, Washington
| | - Deepak Sharma
- Departments of Anesthesiology & Pain Medicine, University of Washington, Sea-ttle, Washington
| | | | - Kwesi Agyem
- Department of Radio-logy, University of Washington, Seattle, Washington
| | - Charles Mock
- Departments of Surgery and Epidemiology, University of Washing-ton, Seattle, Washington
| | - R M Pandey
- Department of Epidemiology, All India Institute of Medical Sciences, New Delhi, India
| | - H H Dash
- Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Center, New Delhi, India
| | - Ashok Mahapatra
- Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Center, New Delhi, India
| | - Deepak Gupta
- Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Center, New Delhi, India
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Harary M, Dolmans RGF, Gormley WB. Intracranial Pressure Monitoring-Review and Avenues for Development. Sensors (Basel) 2018; 18:E465. [PMID: 29401746 PMCID: PMC5855101 DOI: 10.3390/s18020465] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/25/2018] [Accepted: 02/01/2018] [Indexed: 12/27/2022]
Abstract
Intracranial pressure (ICP) monitoring is a staple of neurocritical care. The most commonly used current methods of monitoring in the acute setting include fluid-based systems, implantable transducers and Doppler ultrasonography. It is well established that management of elevated ICP is critical for clinical outcomes. However, numerous studies show that current methods of ICP monitoring cannot reliably define the limit of the brain's intrinsic compensatory capacity to manage increases in pressure, which would allow for proactive ICP management. Current work in the field hopes to address this gap by harnessing live-streaming ICP pressure-wave data and a multimodal integration with other physiologic measures. Additionally, there is continued development of non-invasive ICP monitoring methods for use in specific clinical scenarios.
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Affiliation(s)
- Maya Harary
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Rianne G F Dolmans
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Department of Neurosurgery, University Medical Center, 3584 CS Utrecht, The Netherlands.
| | - William B Gormley
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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19
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Aiolfi A, Benjamin E, Khor D, Inaba K, Lam L, Demetriades D. Brain Trauma Foundation Guidelines for Intracranial Pressure Monitoring: Compliance and Effect on Outcome. World J Surg 2018; 41:1543-1549. [PMID: 28188356 DOI: 10.1007/s00268-017-3898-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Brain Trauma Foundation (BTF) guidelines recommend intracranial pressure (ICP) monitoring in patients who sustained severe traumatic brain injury (TBI). Compliance to BTF guidelines is variable, and the effect of ICP monitoring on outcomes remains a controversial issue. The purpose of this study was to assess guidelines compliance in patients who sustain a severe TBI and to analyze the effect of ICP monitoring on outcomes. METHODS Trauma Quality Improvement Program database study, which included patients with isolated severe blunt head trauma (head Abbreviated Injury Scale ≥3 with Glasgow Coma Scale <9). Patients with severe extracranial injuries excluded. Analyzed variables were demographics, comorbidities, mechanism of injuries, head injury specifics, AIS for each body area, Injury Severity Score, admission vital signs, placement of ICP catheter and craniectomy. Multivariate analysis was used to identify independent predictors for outcomes, overall and in the groups of patients with head AIS 3, 4 or 5. RESULTS During the study period 13,188 patients with isolated severe TBI met the BTF guidelines for ICP monitoring. An ICP catheter was placed in 1519 (11.5%) patients. Stepwise logistic regression analysis identified age ≥65 years, hypotension on admission, AIS 4 and AIS 5 as independent predictors for mortality. ICP monitoring was not an independent protective variable in terms of mortality (OR 1.12; 95% CI, 0.983-1.275; p = 0.088). Overall, ICP monitor placement was independently associated with increased overall complications (OR 2.089; 95% CI, 1.85-2.358; p < 0.001), infectious complications (OR 2.282; 95% CI, 2.015-2.584; p < 0.001) and poor functional independence (OR 1.889; 95% CI, 1.575-2.264; p < 0.001). Sub analysis of the groups of patients with head AIS 3, 4, and 5 failed to show any protective effect of ICP monitors against mortality. In the group of patients with head AIS 4, ICP placement was an independent predictor of mortality (OR 2206; 95% CI, 1652-2948; p < 0.001). CONCLUSIONS Compliance with the BTF guidelines for ICP monitoring is poor. ICP monitoring does not have any survival benefit in patients with isolated severe blunt TBI and is associated with more complications and increased utilization of hospital resources.
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Affiliation(s)
- Alberto Aiolfi
- Division of Acute Care Surgery, University of Southern California, 2051 Marengo Street, Inpatient Tower (C), Rm C5L100, Los Angeles, CA, 90033, USA
| | - Elizabeth Benjamin
- Division of Acute Care Surgery, University of Southern California, 2051 Marengo Street, Inpatient Tower (C), Rm C5L100, Los Angeles, CA, 90033, USA
| | - Desmond Khor
- Division of Acute Care Surgery, University of Southern California, 2051 Marengo Street, Inpatient Tower (C), Rm C5L100, Los Angeles, CA, 90033, USA
| | - Kenji Inaba
- Division of Acute Care Surgery, University of Southern California, 2051 Marengo Street, Inpatient Tower (C), Rm C5L100, Los Angeles, CA, 90033, USA
| | - Lydia Lam
- Division of Acute Care Surgery, University of Southern California, 2051 Marengo Street, Inpatient Tower (C), Rm C5L100, Los Angeles, CA, 90033, USA
| | - Demetrios Demetriades
- Division of Acute Care Surgery, University of Southern California, 2051 Marengo Street, Inpatient Tower (C), Rm C5L100, Los Angeles, CA, 90033, USA.
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20
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El-menyar A, Mekkodathil A, Al-thani H, Consunji R, Latifi R. Incidence, Demographics, and Outcome of Traumatic Brain Injury in The Middle East: A Systematic Review. World Neurosurg 2017; 107:6-21. [DOI: 10.1016/j.wneu.2017.07.070] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 11/21/2022]
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21
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Piccinini A, Lewis M, Benjamin E, Aiolfi A, Inaba K, Demetriades D. Intracranial pressure monitoring in severe traumatic brain injuries: a closer look at level 1 trauma centers in the United States. Injury 2017; 48:1944-1950. [PMID: 28495204 DOI: 10.1016/j.injury.2017.04.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 04/01/2017] [Accepted: 04/14/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Brain Trauma Foundation (BTF) recently updated recommendations for intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI). The effect of ICP monitoring on outcomes is controversial, and compliance with BTF guidelines is variable. The purpose of this study was to assess both compliance and outcomes at level I trauma centers. MATERIALS AND METHODS The American College of Surgeons Trauma Quality Improvement Program database was queried for all patients admitted to level I trauma centers with isolated blunt severe TBI (AIS>3, GCS<9) who met criteria for ICP monitoring. Patients who had severe extracranial injuries, craniectomy, or death in the first 24h were excluded. Comparison between groups with and without ICP monitoring was made, analyzing demographics, comorbidities, mechanism of injury, head Abbreviated Injury Scale (AIS), vital signs on admission, head CT scan findings. Outcomes included in-hospital mortality, mechanical ventilation days, intensive care unit (ICU) length of stay, hospital length of stay, systemic complications, and functional independence at discharge. Multivariable analysis was used to identify independent risk factors for each of the outcomes. RESULTS Overall, 4880 patients were included. ICP monitoring was used in 529 patients (10.8%). Stepwise logistic regression analysis identified ICP monitor placement as an independent risk factor for mortality (OR 1.63; 95% CI 1.28-2.07; p<0.001), mechanical ventilation (OR 5.74 95% CI 4.42-7.46; p<0.001), ICU length of stay (OR 4.03; 95% CI 2.94-5.52; p<0.001), systemic complications (OR 2.78; 95% CI 2.29-3.37; p<0.001), and decreased functional independence at discharge (OR 1.71 95% CI 1.29-2.26; p<0.001). Subgroup analysis of patients with head AIS 3, 4, and 5 confirmed that ICP monitors remained an independent risk factor for mortality in both head AIS 4 and 5. CONCLUSIONS Compliance with BTF guidelines for ICP monitoring is low, even at level I trauma centers. In this study, ICP monitoring was associated with poor outcomes, and was found to be an independent risk factor for mortality. Further studies are needed to determine the optimal role of ICP monitoring in the management of severe TBI.
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Affiliation(s)
- Alice Piccinini
- Division of Trauma, Emergency Surgery and Surgical Critical Care, University of Sourhern California, Los Angeles, CA, USA
| | - Meghan Lewis
- Division of Trauma, Emergency Surgery and Surgical Critical Care, University of Sourhern California, Los Angeles, CA, USA
| | - Elizabeth Benjamin
- Division of Trauma, Emergency Surgery and Surgical Critical Care, University of Sourhern California, Los Angeles, CA, USA
| | - Alberto Aiolfi
- Division of Trauma, Emergency Surgery and Surgical Critical Care, University of Sourhern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Trauma, Emergency Surgery and Surgical Critical Care, University of Sourhern California, Los Angeles, CA, USA
| | - Demetrios Demetriades
- Division of Trauma, Emergency Surgery and Surgical Critical Care, University of Sourhern California, Los Angeles, CA, USA.
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Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GWJ, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery 2017; 80:6-15. [PMID: 27654000 DOI: 10.1227/neu.0000000000001432] [Citation(s) in RCA: 1812] [Impact Index Per Article: 258.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/14/2016] [Indexed: 12/13/2022] Open
Abstract
The scope and purpose of this work is 2-fold: to synthesize the available evidence and to translate it into recommendations. This document provides recommendations only when there is evidence to support them. As such, they do not constitute a complete protocol for clinical use. Our intention is that these recommendations be used by others to develop treatment protocols, which necessarily need to incorporate consensus and clinical judgment in areas where current evidence is lacking or insufficient. We think it is important to have evidence-based recommendations to clarify what aspects of practice currently can and cannot be supported by evidence, to encourage use of evidence-based treatments that exist, and to encourage creativity in treatment and research in areas where evidence does not exist. The communities of neurosurgery and neuro-intensive care have been early pioneers and supporters of evidence-based medicine and plan to continue in this endeavor. The complete guideline document, which summarizes and evaluates the literature for each topic, and supplemental appendices (A-I) are available online at https://www.braintrauma.org/coma/guidelines.
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Affiliation(s)
- Nancy Carney
- Oregon Health & Science University, Portland, Oregon
| | | | | | - Jamie S Ullman
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York
| | | | | | | | | | | | - Niranjan Kissoon
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andres M Rubiano
- El Bosque University, Bogota, Colombia
- MEDITECH Foundation, Neiva, Colombia
| | - Lori Shutter
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert C Tasker
- Harvard Medical School & Boston Children's Hospital, Boston, Massachusetts
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23
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Shen L, Wang Z, Su Z, Qiu S, Xu J, Zhou Y, Yan A, Yin R, Lu B, Nie X, Zhao S, Yan R. Effects of Intracranial Pressure Monitoring on Mortality in Patients with Severe Traumatic Brain Injury: A Meta-Analysis. PLoS One 2016; 11:e0168901. [PMID: 28030638 PMCID: PMC5193438 DOI: 10.1371/journal.pone.0168901] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/05/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Brain Trauma Foundation (BTF) guidelines published in 2007 suggest some indications for intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI). However, some studies had not shown clinical benefit in patients with severe TBI; several studies had even reported that ICP monitoring was associated with an increased mortality rate. The effect of ICP monitoring has remained controversial, regardless of the ICP monitoring guidelines. Here we performed a meta-analysis of published studies to assess the effects of ICP monitoring in patients with severe TBI. METHODS We searched three comprehensive databases, the Cochrane Library, PUBMED, and EMBASE, for studies without limitations published up to September 2015. Mortality, ICU LOS, and hospital LOS were analyzed with Review Manager software according to data from the included studies. RESULTS Eighteen eligible studies involving 25229 patients with severe TBI were included in our meta-analysis. The results indicated no significant reduction in the ICP monitored group in mortality (hospitalized before 2007), hospital mortality (hospitalized before 2007), mortality in randomized controlled trials. However, overall mortality, mortality (hospitalized after 2007), hospital mortality (hospitalized after 2007), mortality in observational studies (hospitalized after 2007), 2-week mortality, 6-month mortality, were reduced in ICP monitored group. Patients with an increased ICP were more likely to require ICP monitoring. CONCLUSION Superior survival was observed in severe TBI patients with ICP monitoring since the third edition of "Guidelines for the Management of Severe Traumatic Brain Injury," which included "Indications for intracranial pressure monitoring," was published in 2007.
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Affiliation(s)
- Liang Shen
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Zhuo Wang
- Department of Medical College, Nursing College of Huzhou University, Huzhou, Zhejiang, China
| | - Zhongzhou Su
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Sheng Qiu
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Jie Xu
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Yue Zhou
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Ai Yan
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Rui Yin
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Bin Lu
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Xiaohu Nie
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Shufa Zhao
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Renfu Yan
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China
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García-Lira JR, Zapata-Vázquez RE, Alonzo-Vázquez F, Rodríguez-Ruz SG, Medina-Moreno MR, Torres-Escalante JL. [Monitoring intracranial pressure in severe traumatic brain injury]. Rev Chil Pediatr 2016; 87:387-394. [PMID: 27296717 DOI: 10.1016/j.rchipe.2016.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 03/18/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Severe traumatic brain injury (TBI) is a serious condition. Intracranial pressure (ICP) monitoring can be used to direct treatment, which is of limited access in developing countries. OBJECTIVE To describe the clinical experience of pediatric patients with severe TBI. PATIENTS AND METHOD A clinical experience in patients with severe TBI was conducted. Age was 1-17 years, exclusion criteria were chronic illness and psicomotor retardation. Informed consent was obtained in each case. Two groups were formed based on the criterion of neurosurgeons: with and without intracraneal pressure (ICP) monitoring. PIC monitoring was performed through a 3PN Spiegelberg catheter and a Spiegelberg HDM 26 monitor. Patients were treated according international pediatric guides. The characteristics of both groups are described at 6 months of follow-up. RESULTS Forty-two patients (CM=14 and SM=28). Those in the CM Group had lower Glasgow coma scale score and Marshall classification with poorer prognosis. Among them survival rate was lower, although the outcome was from moderate to good. No complications were reported with the use of the ICP catheter. CONCLUSION Patients with ICP monitoring had greater severity at admission and an increased mortality; however, the outcome for the survivors was from moderate to good. It is necessary to conduct randomized clinical trials to define the impact of ICP monitoring on survival and quality of life in severe TBI patients.
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Affiliation(s)
| | - Rita Esther Zapata-Vázquez
- Unidad Interinstitucional de Investigación Clínica y Epidemiológica, Facultad de Medicina, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
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25
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Han J, Yang S, Zhang C, Zhao M, Li A. Impact of Intracranial Pressure Monitoring on Prognosis of Patients With Severe Traumatic Brain Injury: A PRISMA Systematic Review and Meta-Analysis. Medicine (Baltimore) 2016; 95:e2827. [PMID: 26886639 PMCID: PMC4998639 DOI: 10.1097/md.0000000000002827] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
To evaluate the influences of using intracranial pressure (ICP) monitoring on the prognosis of patients with severe traumatic brain injury. Systematic search were conducted in PubMed, Embase, Cochrane Library, Wanfang, and CNKI. The eligible studies were identified for pooling analysis under fixed- or random effects model. Hospital mortality, functional outcomes, length of hospital stay, and the related complications in patients were extracted. Six randomized controlled trials with 880 cases and 12 cohort studies with 12,606 cases were included. Combined analysis found that ICP monitoring was effective for reducing the risk rate of electrolyte disturbances (RR = 0.47, 95% confidence interval (CI): 0.63-0.90), rate of renal failure (RR = 0.50, 95% CI: 0.30-0.83), and for improving favorable prognosis (RR = 1.15, 95% CI: 1.00-1.35). However, ICP monitoring was not significant for hospital mortality (RR = 0.91, 95% CI: 0.77-0.1.06), decreasing rate of pulmonary infection (RR = 0.93, 95% CI: 0.76-1.14), rate of mechanical ventilation (RR = 1.02, 95% CI: 0.86-1.09), and duration of hospital stays (weighted mean difference (WMD) = 0.06, 95% CI: -0.03, 0.16). ICP monitoring may not reduce the risk of hospital mortality, but plays a role in decreasing the rate of electrolyte disturbances, rate of renal failure, and increasing favorable functional outcome. However, effect of other outcomes need to be further confirmed in the future randomized controlled trials (RCTs) with larger sample size.
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Affiliation(s)
- Jinsong Han
- From the Department of Neurosurgery, First Affiliated Hospital of Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing (JH, SY, MZ, AL); Quanjian Tumor Hospital of Tianjin, Tianjin (SY); and Department of Medical Reform and Development, China-Japan Friendship Hospital, Beijing (CZ), China
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26
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O'Lynnger TM, Shannon CN, Le TM, Greeno A, Chung D, Lamb FS, Wellons JC. Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge. J Neurosurg Pediatr 2016; 17:19-26. [PMID: 26451717 DOI: 10.3171/2015.5.peds1544] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The goal of critical care in treating traumatic brain injury (TBI) is to reduce secondary brain injury by limiting cerebral ischemia and optimizing cerebral blood flow. The authors compared short-term outcomes as defined by discharge disposition and Glasgow Outcome Scale scores in children with TBI before and after the implementation of a protocol that standardized decision-making and interventions among neurosurgeons and pediatric intensivists. METHODS The authors performed a retrospective pre- and postprotocol study of 128 pediatric patients with severe TBI, as defined by Glasgow Coma Scale (GCS) scores < 8, admitted to a tertiary care center pediatric critical care unit between April 1, 2008, and May 31, 2014. The preprotocol group included 99 patients, and the postprotocol group included 29 patients. The primary outcome of interest was discharge disposition before and after protocol implementation, which took place on April 1, 2013. Ordered logistic regression was used to assess outcomes while accounting for injury severity and clinical parameters. Favorable discharge disposition included discharge home. Unfavorable discharge disposition included discharge to an inpatient facility or death. RESULTS Demographics were similar between the treatment periods, as was injury severity as assessed by GCS score (mean 5.43 preprotocol, mean 5.28 postprotocol; p = 0.67). The ordered logistic regression model demonstrated an odds ratio of 4.0 of increasingly favorable outcome in the postprotocol cohort (p = 0.007). Prior to protocol implementation, 63 patients (64%) had unfavorable discharge disposition and 36 patients (36%) had favorable discharge disposition. After protocol implementation, 9 patients (31%) had unfavorable disposition, while 20 patients (69%) had favorable disposition (p = 0.002). In the preprotocol group, 31 patients (31%) died while 6 patients (21%) died after protocol implementation (p = 0.04). CONCLUSIONS Discharge disposition and mortality rates in pediatric patients with severe TBI improved after implementation of a standardized protocol among caregivers based on best-practice guidelines.
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Affiliation(s)
| | | | - Truc M Le
- Pediatrics, Division of Pediatric Critical Care Medicine, and
| | - Amber Greeno
- Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dai Chung
- Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fred S Lamb
- Pediatrics, Division of Pediatric Critical Care Medicine, and
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27
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Chesnut R, Videtta W, Vespa P, Le Roux P. Intracranial pressure monitoring: fundamental considerations and rationale for monitoring. Neurocrit Care 2015; 21 Suppl 2:S64-84. [PMID: 25208680 DOI: 10.1007/s12028-014-0048-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Traumatic brain injury (TBI) is a major cause of death and disability worldwide. In large part critical care for TBI is focused on the identification and management of secondary brain injury. This requires effective neuromonitoring that traditionally has centered on intracranial pressure (ICP). The purpose of this paper is to review the fundamental literature relative to the clinical application of ICP monitoring in TBI critical care and to provide recommendations on how the technique maybe applied to help patient management and enhance outcome. A PubMed search between 1980 and September 2013 identified 2,253 articles; 244 of which were reviewed in detail to prepare this report and the evidentiary tables. Several important concepts emerge from this review. ICP monitoring is safe and is best performed using a parenchymal monitor or ventricular catheter. While the indications for ICP monitoring are well established, there remains great variability in its use. Increased ICP, particularly the pattern of the increase and ICP refractory to treatment is associated with increased mortality. Class I evidence is lacking on how monitoring and management of ICP influences outcome. However, a large body of observational data suggests that ICP management has the potential to influence outcome, particularly when care is targeted and individualized and supplemented with data from other monitors including the clinical examination and imaging.
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Affiliation(s)
- Randall Chesnut
- Brain and Spine Center, Suite 370, Medical Science Building, Lankenau Medical Center, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA
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28
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Dang Q, Simon J, Catino J, Puente I, Habib F, Zucker L, Bukur M. More fateful than fruitful? Intracranial pressure monitoring in elderly patients with traumatic brain injury is associated with worse outcomes. J Surg Res 2015; 198:482-8. [PMID: 25972315 DOI: 10.1016/j.jss.2015.03.092] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/16/2015] [Accepted: 03/27/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND In an expanding elderly population, traumatic brain injury (TBI) remains a significant cause of death and disability. Guidelines for management of TBI, according to the Brain Trauma Foundation (BTF), include intracranial pressure (ICP) monitoring. Whether ICP monitoring contributes to outcomes in the elderly patients with TBI has not been explored. METHODS This is a retrospective study extracted from the National Trauma Database 2007-2008 research datasets. Patients were included if aged >55 y and they met BTF indications for ICP monitoring. Patients that had nonsurvivable injuries (any body region, abbreviated injury score = 6), were dead on arrival, had withdrawal of care, or length of stay <48 h were excluded. Outcomes were then stratified based on ICP monitoring. The primary outcomes were inhospital mortality and favorable discharge. Logistic regression was used to analyze the effect of ICP monitoring on outcomes. RESULTS A total of 4437 patients were included with 11.2% having an ICP monitor placed. Patients requiring an ICP monitor were younger overall, more likely to present hypertensive, had higher injury severity, and more likely to require operative intervention. Median initial Glasgow coma scale (3) was similar between groups. Of those patients with ICP monitoring, overall mortality was significantly higher, and they were less likely to have favorable discharge status. Craniotomy itself was not associated with increased mortality (P = 0.450). CONCLUSIONS Our findings suggest that the use of ICP monitoring according to BTF guidelines in elderly TBI patients does not provide outcomes superior to treatment without monitoring. The ideal group to benefit from ICP monitor placement remains to be elucidated.
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Affiliation(s)
- Quoc Dang
- Department of Surgery, Larkin Community Hospital, South Miami, Florida; Division of Trauma and Critical Care, Delray Medical Center, Delray Beach, Florida.
| | - Joshua Simon
- Department of Surgery, Larkin Community Hospital, South Miami, Florida; Division of Trauma and Critical Care, Delray Medical Center, Delray Beach, Florida
| | - Joe Catino
- Division of Trauma and Critical Care, Delray Medical Center, Delray Beach, Florida; Division of Trauma and Critical Care, Broward General Hospital, Fort Lauderdale, Florida
| | - Ivan Puente
- Division of Trauma and Critical Care, Delray Medical Center, Delray Beach, Florida; Division of Trauma and Critical Care, Broward General Hospital, Fort Lauderdale, Florida
| | - Fahim Habib
- Division of Trauma and Critical Care, Delray Medical Center, Delray Beach, Florida; Division of Trauma and Critical Care, Broward General Hospital, Fort Lauderdale, Florida
| | - Lloyd Zucker
- Division of Trauma and Critical Care, Delray Medical Center, Delray Beach, Florida
| | - Marko Bukur
- Division of Trauma and Critical Care, Delray Medical Center, Delray Beach, Florida; Division of Trauma and Critical Care, Broward General Hospital, Fort Lauderdale, Florida
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29
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Yuan Q, Wu X, Sun Y, Yu J, Li Z, Du Z, Mao Y, Zhou L, Hu J. Impact of intracranial pressure monitoring on mortality in patients with traumatic brain injury: a systematic review and meta-analysis. J Neurosurg 2014; 122:574-87. [PMID: 25479125 DOI: 10.3171/2014.10.jns1460] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECT Some studies have demonstrated that intracranial pressure (ICP) monitoring reduces the mortality of traumatic brain injury (TBI). But other studies have shown that ICP monitoring is associated with increased mortality. Thus, the authors performed a meta-analysis of studies comparing ICP monitoring with no ICP monitoring in patients who have suffered a TBI to determine if differences exist between these strategies with respect to mortality, intensive care unit (ICU) length of stay (LOS), and hospital LOS. METHODS The authors systematically searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (Central) from their inception to October 2013 for relevant studies. Randomized clinical trials and prospective cohort, retrospective observational cohort, and case-control studies that compared ICP monitoring with no ICP monitoring for the treatment of TBI were included in the analysis. Studies included had to report at least one point of mortality in an ICP monitoring group and a no-ICP monitoring group. Data were extracted for study characteristics, patient demographics, baseline characteristics, treatment details, and study outcomes. RESULTS A total of 14 studies including 24,792 patients were analyzed. The meta-analysis provides no evidence that ICP monitoring decreased the risk of death (pooled OR 0.93 [95% CI 0.77-1.11], p = 0.40). However, 7 of the studies including 12,944 patients were published after 2012 (January 2012 to October 2013), and they revealed that ICP monitoring was significantly associated with a greater decrease in mortality than no ICP monitoring (pooled OR 0.56 [95% CI 0.41-0.78], p = 0.0006). In addition, 7 of the studies conducted in North America showed no evidence that ICP monitoring decreased the risk of death, similar to the studies conducted in other regions. ICU LOSs were significantly longer for the group subjected to ICP monitoring (mean difference [MD] 0.29 [95% CI 0.21-0.37]; p < 0.00001). In the pooled data, the hospital LOS with ICP monitoring was also significantly longer than with no ICP monitoring (MD 0.21 [95% CI 0.04-0.37]; p = 0.01). CONCLUSIONS In this systematic review and meta-analysis of ICP monitoring studies, the authors found that the current clinical evidence does not indicate that ICP monitoring overall is significantly superior to no ICP monitoring in terms of the mortality of TBI patients. However, studies published after 2012 indicated a lower mortality in patients who underwent ICP monitoring.
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Affiliation(s)
- Qiang Yuan
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, PR China
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30
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Bothe MK, Stover JF. Monitoring of acute traumatic brain injury in adults to prevent secondary brain damage. Future Neurology 2014. [DOI: 10.2217/fnl.13.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT: Traumatic brain injury is typically characterized by the primary injury initiating a cascade of pathologic changes that then lead to secondary brain injury. Secondary brain injury is amenable to different therapeutic options. Monitoring of otherwise occult pathologic changes involving oxygenation and metabolism is crucial for treatment decisions. Currently, decision-making is mainly based on measuring intracranial pressure and cerebral perfusion pressure. Importantly, extending neuromonitoring by including parameters reflecting cerebral perfusion, oxygenation and metabolism may improve treatment of traumatic brain injury patients by detecting neuronal damage despite optimal intracranial pressure or cerebral perfusion pressure and preventing unnecessarily aggressive treatment potentially causing local and systemic harm. In this review, the authors describe the advantages and disadvantages of contemporary, extended neuromonitoring methods in traumatic brain injury patients aimed at unmasking secondary brain damage as early as possible.
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Affiliation(s)
- Melanie K Bothe
- Fresenius Kabi Deutschland GmbH, Rathausplatz 3, 61348 Bad Homburg, Germany
| | - John F Stover
- Fresenius Kabi Deutschland GmbH, Rathausplatz 3, 61348 Bad Homburg, Germany
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31
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Egea-Guerrero JJ, Murillo-Cabezas F, Gordillo-Escobar E, Rodríguez-Rodríguez A, Enamorado-Enamorado J, Revuelto-Rey J, Pacheco-Sánchez M, León-Justel A, Domínguez-Roldán JM, Vilches-Arenas A. S100B protein may detect brain death development after severe traumatic brain injury. J Neurotrauma 2013; 30:1762-9. [PMID: 23710646 PMCID: PMC3796324 DOI: 10.1089/neu.2012.2606] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Despite improvements in the process of organ donation and transplants, the number of organ donors is progressively declining in developed countries. Therefore, the early detection of patients at risk for brain death (BD) is a priority for transplant teams seeking more efficient identification of potential donors. In the extensive literature on S100B as a biomarker for traumatic brain injury (TBI), no evidence appears to exist on its prognostic capacity as a predictor of BD after severe TBI. The objective of this study is to assess the value of including acute S100B levels in standard clinical data as an early screening tool for BD after severe TBI. This prospective study included patients with severe TBI (Glasgow Coma Scale score [GCS] ≤ 8) admitted to our Neurocritical Care Unit over a 30 month period. We collected the following clinical variables: age, gender, GCS score, pupillary alterations at admission, hypotension and pre-hospital desaturation, CT scan results, isolated TBI or other related injuries, Injury Severity Score (ISS), serum S100B levels at admission and 24 h post-admission, and a final diagnosis regarding BD. Of the 140 patients studied, 11.4% developed BD and showed significantly higher S100B concentrations (p<0.001). Multivariate analysis showed that bilateral unresponsive mydriasis at admission and serum S100B at 24 h post-admission had odds ratios (ORs) of 21.35 (p=0.005) and 4.9 (p=0.010), respectively. The same analysis on patients with photomotor reflex in one pupil at admission left only the 24 h S100B sample in the model (OR=15.5; p=0.009). Receiver operating characteristics (ROC) curve analysis on this group showed the highest area under the curve (AUC) (0.86; p=0.001) for 24 h S100B determinations. The cut off was set at 0.372 μg/L (85.7% sensitivity, 79.3% specificity, positive predictive value [PPV]=18.7% and negative predictive value [NPV]=98.9%). This study shows that pupillary responsiveness at admission, as well as 24 h serum S100B levels, could serve as screening tools for the early detection of patients at risk for BD after severe TBI.
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Affiliation(s)
- Juan J. Egea-Guerrero
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Francisco Murillo-Cabezas
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Elena Gordillo-Escobar
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Ana Rodríguez-Rodríguez
- Department of Clinical Biochemistry, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Judy Enamorado-Enamorado
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Jaume Revuelto-Rey
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - María Pacheco-Sánchez
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Antonio León-Justel
- Department of Clinical Biochemistry, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Jose M. Domínguez-Roldán
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Angel Vilches-Arenas
- Department of Preventive Medicine and Public Health, IBIS/CSIC/University of Seville, Seville, Spain
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Abstract
Traumatic brain injury (TBI) is a major medical and socio-economic problem, and is the leading cause of death in children and young adults. The critical care management of severe TBI is largely derived from the "Guidelines for the Management of Severe Traumatic Brain Injury" that have been published by the Brain Trauma Foundation. The main objectives are prevention and treatment of intracranial hypertension and secondary brain insults, preservation of cerebral perfusion pressure (CPP), and optimization of cerebral oxygenation. In this review, the critical care management of severe TBI will be discussed with focus on monitoring, avoidance and minimization of secondary brain insults, and optimization of cerebral oxygenation and CPP.
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Affiliation(s)
- Samir H Haddad
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
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