Intracranial pressure monitoring in traumatic brain injury

Romner, Bertil; Grände, Per‐Olof

doi:10.1038/nrneurol.2013.37

Cited by 28 publications

(16 citation statements)

References 9 publications

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“…Recently, the effectiveness of ICP monitoring in patients with TBI has been challenged by the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure (BEST-TRIP) trial [32], leading some clinicians to question the value of ICP measurement in TBI. At this stage, to carefully analyze and adequately interpret this important study is of utmost importance [33][34][35][36]. The BEST-TRIP trial compared two management protocols, one ICP based and the other driven by computed tomography scan and neurologic examination.…”

Section: Intracranial and Cerebral Perfusion Pressure Monitoringmentioning

confidence: 99%

Recommendations for the use of multimodal monitoring in the neurointensive care unit

Citerio

Oddo

Taccone

2015

Current Opinion in Critical Care

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MMM allows comprehensive exploration of the complex pathophysiology of acute brain damage and, depending on the different configuration of the pathological condition we are treating, the application of targeted individualized care. Unfortunately, we still lack robust evidence on how to better integrate MMM-derived information at the bedside to improve patient management. Advanced informatics is promising and may provide us a supportive tool to interpret physiologic events and guide pathophysiological-based therapeutic decisions.

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Section: Intracranial and Cerebral Perfusion Pressure Monitoringmentioning

confidence: 99%

Recommendations for the use of multimodal monitoring in the neurointensive care unit

Citerio

Oddo

Taccone

2015

Current Opinion in Critical Care

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“…In patients with severe TBI, increased intracranial pressure (ICP) and hypertension are common causes of poor neurological outcomes and death. 1,22,24,46,47,53 Cerebral ischemia and elevated ICP cause secondary injury, which can be relieved by surgical decompression. 1,7,10,20,22,24,36,51,53,58,59,61,66 Craniectomy removes compressive elements from the tissue so that the edematous brain swells outward rather than downward, herniation is prevented, and adequate vascular perfusion is maintained.…”

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confidence: 99%

Effects of early surgical decompression on functional and histological outcomes after severe experimental thoracic spinal cord injury

Jalan

Saini

Zaidi

et al. 2017

SPI

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OBJECTIVE In acute traumatic brain injury, decompressive craniectomy is a common treatment that involves the removal of bone from the cranium to relieve intracranial pressure. The present study investigated whether neurological function following a severe spinal cord injury improves after utilizing either a durotomy to decompress the intradural space and/or a duraplasty to maintain proper flow of cerebrospinal fluid. METHODS Sixty-four adult female rats (n = 64) were randomly assigned to receive either a 3- or 5-level decompressive laminectomy (Groups A and B), laminectomy + durotomy (Groups C and D), or laminectomy + duraplasty with graft (Group E and F) at 24 hours following a severe thoracic contusion injury (200 kilodynes). Duraplasty involved the use of DuraSeal, a hydrogel dural sealant. Uninjured and injured control groups were included (Groups G, H). Hindlimb locomotor function was assessed by open field locomotor testing (BBB) and CatWalk gait analysis at 35 days postinjury. Bladder function was analyzed and bladder wall thickness was assessed histologically. At 35 days postinjury, mechanical and thermal allodynia were assessed by the Von Frey hair filament and hotplate paw withdrawal tests, respectively. Thereafter, the spinal cords were dissected, examined for gross anomalies at the injury site, and harvested for histological analyses to assess lesion volumes and white matter sparing. ANOVA was used for statistical analyses. RESULTS There was no significant improvement in motor function recovery in any treatment groups compared with injured controls. CatWalk gait analysis indicated a significant decrease in interlimb coordination in Groups B, C, and D (p < 0.05) and swing speed in Groups A, B, and D. Increased mechanical pain sensitivity was observed in Groups A, C, and F (p < 0.05). Rats in Group C also developed thermal pain hypersensitivity. Examination of spinal cords demonstrated increased lesion volumes in Groups C and F and increased white matter sparing in Group E (p < 0.05). The return of bladder automaticity was similar in all groups. Examination of the injury site during tissue harvest revealed that, in some instances, expansion of the hydrogel dural sealant caused compression of the spinal cord. CONCLUSIONS Surgical decompression provided no benefit in terms of neurological improvement in the setting of a severe thoracic spinal cord contusion injury in rats at 24 hours postinjury. Decompressive laminectomy and durotomy did not improve motor function recovery, and rats in both of these treatment modalities developed neuropathic pain. Performing a durotomy also led to increased lesion volumes. Placement of DuraSeal was shown to cause compression in some rats in the duraplasty treatment groups. Decompressive duraplasty of 3 levels does not affect functional outcomes after injury but did increase white matter sparing. Decompressive duraplasty of 5 levels led to neuropathic pain development and increased lesion volumes. Further comparison of dural repair techniques is necessary.

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“…Public health implications have included limitation of insurance reimbursement for ICP monitors in Brazil. Interpretation has also varied widely in published analyses [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. There is a paucity of studies amenable to resolving such controversy in this area, as summarized in the Guidelines for the Management of Severe Traumatic Brain Injury in Adults from the Brain Trauma Foundation (BTF)19 .…”

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confidence: 99%

A Consensus-Based Interpretation of the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure Trial

Chesnut

Bleck

Citerio

et al. 2015

Journal of Neurotrauma

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Widely-varying published and presented analyses of the Benchmark Evidence From South American Trials: Treatment of Intracranial Pressure (BEST TRIP) randomized controlled trial of intracranial pressure (ICP) monitoring have suggested denying trial generalizability, questioning the need for ICP monitoring in severe traumatic brain injury (sTBI), re-assessing current clinical approaches to monitored ICP, and initiating a general ICP-monitoring moratorium. In response to this dissonance, 23 clinically-active, international opinion leaders in acute-care sTBI management met to draft a consensus statement to interpret this study. A Delphi method-based approach employed iterative pre-meeting polling to codify the group's general opinions, followed by an in-person meeting wherein individual statements were refined. Statements required an agreement threshold of more than 70% by blinded voting for approval. Seven precisely-worded statements resulted, with agreement levels of 83% to 100%. These statements, which should be read in toto to properly reflect the group's consensus positions, conclude that the BEST TRIP trial: 1) studied protocols, not ICP-monitoring per se; 2) applies only to those protocols and specific study groups and should not be generalized to other treatment approaches or patient groups; 3) strongly calls for further research on ICP interpretation and use; 4) should be applied cautiously to regions with much different treatment milieu; 5) did not investigate the utility of treating monitored ICP in the specific patient group with established intracranial hypertension; 6) should not change the practice of those currently monitoring ICP; and 7) provided a protocol, used in non-monitored study patients, that should be considered when treating without ICP monitoring. Consideration of these statements can clarify study interpretation.

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Intracranial pressure monitoring in traumatic brain injury

Cited by 28 publications

References 9 publications

Recommendations for the use of multimodal monitoring in the neurointensive care unit

Recommendations for the use of multimodal monitoring in the neurointensive care unit

Effects of early surgical decompression on functional and histological outcomes after severe experimental thoracic spinal cord injury

A Consensus-Based Interpretation of the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure Trial

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