Management of raised intracranial pressure in children with traumatic brain injury

Kukreti, Vinay; Mohseni-Bod, Hadi; Drake, James M.

doi:10.4103/1817-1745.147572

Cited by 40 publications

(18 citation statements)

References 88 publications

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“…The recommendations for ICP monitoring in comatose TBI patients, as per the common consensus arrived by expert neurosurgeons and intensivists [ 127 ], are: (i) may not be required with normal initial CT scan; (ii) is recommended with early CT scans showing minimal signs of injury if the initial findings worsen over time; and (iii) should be performed if initial CT scan demonstrates diffuse injury with signs of brain swelling. Despite some controversies, ICP monitoring remains important in guiding treatment particularly after severe TBI, and is accepted as a standard of care in developed countries [ 128 , 129 ]. ICP management has the potential to influence clinical outcome, especially with supplemental data from monitoring like clinical examination and imaging, in particular when targeted and individualized treatment is provided [ 129 ].…”

Section: Role Of Icp Monitoring In Traumatic Brain Injurymentioning

confidence: 99%

Advances in Intracranial Pressure Monitoring and Its Significance in Managing Traumatic Brain Injury

Kawoos

McCarron

Auker

et al. 2015

IJMS

118

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Intracranial pressure (ICP) measurements are essential in evaluation and treatment of neurological disorders such as subarachnoid and intracerebral hemorrhage, ischemic stroke, hydrocephalus, meningitis/encephalitis, and traumatic brain injury (TBI). The techniques of ICP monitoring have evolved from invasive to non-invasive—with both limitations and advantages. Some limitations of the invasive methods include short-term monitoring, risk of infection, restricted mobility of the subject, etc. The invasiveness of a method limits the frequency of ICP evaluation in neurological conditions like hydrocephalus, thus hampering the long-term care of patients with compromised ICP. Thus, there has been substantial interest in developing noninvasive techniques for assessment of ICP. Several approaches were reported, although none seem to provide a complete solution due to inaccuracy. ICP measurements are fundamental for immediate care of TBI patients in the acute stages of severe TBI injury. In severe TBI, elevated ICP is associated with mortality or poor clinical outcome. ICP monitoring in conjunction with other neurological monitoring can aid in understanding the pathophysiology of brain damage. This review article presents: (a) the significance of ICP monitoring; (b) ICP monitoring methods (invasive and non-invasive); and (c) the role of ICP monitoring in the management of brain damage, especially TBI.

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Section: Role Of Icp Monitoring In Traumatic Brain Injurymentioning

confidence: 99%

Advances in Intracranial Pressure Monitoring and Its Significance in Managing Traumatic Brain Injury

Kawoos

McCarron

Auker

et al. 2015

IJMS

118

View full text Add to dashboard Cite

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“…Patients with severe TBI (Glasgow Coma Scale [GCS] score ≤ 8), especially those with an abnormal admission computed tomography (CT) scan, have the highest risk of intracranial hypertension (ICH) [7, 8]. Hence, both degree and duration of increased ICP in patients with severe TBI are closely related with poor outcomes [9, 10]. …”

Section: Introductionmentioning

confidence: 99%

Effects of Intracranial Pressure Monitoring on Mortality in Patients with Severe Traumatic Brain Injury: A Meta-Analysis

Shen

Wang

et al. 2016

PLoS ONE

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BackgroundThe 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.MethodsWe 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.ResultsEighteen 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.ConclusionSuperior 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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“…Several reasons may have contributed to this. First, ICP and CPP are inadequate as tools to inform clinicians efficiently about the complex brain pathophysiology underlying pTBI because of the multifactorial contributions to intracranial hypertension ( 33 ). Very dissimilar clinical conditions may result in very similar, yet unpredictable, variations in ICP that may not follow linear relationships as observed for the prolonged lag time existing between ICP variation and metabolic dysfunction, failing to produce the expected outcomes.…”

Section: From Epidemiology To Patient Management: Current Knowledge Amentioning

confidence: 99%

Addressing Key Clinical Care and Clinical Research Needs in Severe Pediatric Traumatic Brain Injury: Perspectives From a Focused International Conference

et al. 2021

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Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children and adolescents. Survivors of severe TBI are more prone to functional deficits, resulting in poorer school performance, poor health-related quality of life (HRQoL), and increased risk of mental health problems. Critical gaps in knowledge of pathophysiological differences between children and adults concerning TBI outcomes, the paucity of pediatric trials and prognostic models and the uncertain extrapolation of adult data to pediatrics pose significant challenges and demand global efforts. Here, we explore the clinical and research unmet needs focusing on severe pediatric TBI to identify best practices in pathways of care and optimize both inpatient and outpatient management of children following TBI.

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Management of raised intracranial pressure in children with traumatic brain injury

Cited by 40 publications

References 88 publications

Advances in Intracranial Pressure Monitoring and Its Significance in Managing Traumatic Brain Injury

Advances in Intracranial Pressure Monitoring and Its Significance in Managing Traumatic Brain Injury

Effects of Intracranial Pressure Monitoring on Mortality in Patients with Severe Traumatic Brain Injury: A Meta-Analysis

Addressing Key Clinical Care and Clinical Research Needs in Severe Pediatric Traumatic Brain Injury: Perspectives From a Focused International Conference

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