Intracranial Pressure Monitoring in Patients With Severe Traumatic Brain Injury: Extension of the Recommendations and the Effect on Outcome by Propensity Score Matching

Abstract

BACKGROUND: Intracranial pressure (ICP) monitoring is recommended for patients with traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) <9 on admission and revealing space-occupying lesions or swelling on computed tomography. However, previous studies that have evaluated its effect on outcome have shown conflicting results. OBJECTIVE: To study the effect of ICP monitoring on outcome after adjustment of patient's characteristics imbalance and determine the potential benefit on patients with higher GCS that deteriorates early or in the absence of computed tomography results suggesting high ICP. METHODS: We searched for adult patients with TBI admitted between 1996 and 2020 with a GCS <9 on admission or deterioration from higher scores within 24 hours after TBI. Patients were divided into groups if they fulfilled strict (Brain Trauma Foundation guidelines) or extended criteria (patients who worsened after admission or without space-occupying lesions) for ICP monitoring. Propensity score analyses based on nearest neighbor matching was performed. RESULTS: After matching, we analyzed data from 454 patients and 184 patients who fulfilled strict criteria or extended criteria for ICP monitoring, respectively. A decreased on in-hospital mortality was detected in monitored patients following strict and extended criteria. Those patients with a higher baseline risk of poor outcome showed higher odds of favorable outcome if they were monitored. CONCLUSION: ICP monitoring in patients with severe TBI within 24 hours after injury following strict and extended criteria was associated with a decreased in-hospital mortality. The identification of patients with a higher risk of an unfavorable outcome might be useful to better select cases that would benefit more from ICP monitoring.

Intracerebral hematomas are capable of altering air-pouch intracranial pressure monitoring

“…The clinical relevance of ICP monitoring has been demonstrated in a myriad of studies and treatment parameters guided by ICP have been associated with improved outcome(s) and mortality. [3,10,11] A threshold of 22 mmHg has been de ned as pathological by the Brain Trauma Foundation guidelines; such ICPs warrant an escalation of medical and/or surgical care. [1] Therefore, a simple and reliable measure of ICP is crucial as physicians/surgeons manage critical ill patients.…”

“…Intracranial pressure (ICP) monitoring is critical in the clinical management of patients with intracranial insults/lesions. [1][2][3] Monitoring with intracerebral pressure probes has become more prevalent as compared to ventricular drain measurements (i.e., the "gold standard"). [4][5][6] It is however prudent to note that no consensus exists with regard to which ICP monitoring modality is ultimately employed clinically.…”

Intracerebral Hematomas are Capable of Altering Air-Pouch Intracranial Pressure Monitoring

“…The clinical relevance of ICP monitoring has been demonstrated in a myriad of studies and treatment parameters guided by ICP have been associated with improved outcome(s) and mortality. [3,10,11] A threshold of 22 mmHg has been defined as pathological by the Brain Trauma Foundation guidelines; such ICPs warrant an escalation of medical and/or surgical care. [1] Therefore, a simple and reliable measure of ICP is crucial as physicians/surgeons manage critical ill patients.…”

“…Intracranial pressure (ICP) monitoring is critical in the clinical management of patients with intracranial insults/lesions. [1][2][3] Monitoring with intracerebral pressure probes has become more prevalent as compared to ventricular drain measurements (i.e., the "gold standard"). [4][5][6] It is however prudent to note that no consensus exists with regard to which ICP monitoring modality is ultimately employed clinically.…”

Beyond intracranial pressure: monitoring cerebral perfusion and autoregulation in severe traumatic brain injury

“…However, patients in the non-ICP monitoring arm received massive anti-intracranial hypertension therapies. Other studies, which were done retrospectively, showed an improved outcome and lower mortality in ICP-steered treatment [7][8][9]. Recently, the results of the Synapse-ICU observational trial confirmed that patients in whom ICP was monitored not only had higher therapeutic intensity levels to lower ICP but also better neurological outcome at 6 months (extended Glasgow Outcome Scale, GOSE).…”