Outcome of severe traumatic brain injury: comparison of three monitoring approaches

Abstract

<jats:p>The determination of cerebral perfusion pressure (CPP) is regarded as vital in monitoring patients with severe traumatic brain injury. Besides indicating the status of cerebral blood flow (CBF), it also reveals the status of intracranial pressure (ICP). The abnormal or suboptimal level of CPP is commonly correlated with high values of ICP and therefore with poor patient outcomes. Eighty-two patients were divided into three groups of patients receiving treatment based on CPP and CBF, ICP alone, and conservative methods during two different observation periods. The characteristics of these three groups were compared based on age, sex, time between injury and hospital arrival, Glasgow Coma Scale score, pupillary reaction to light, surgical intervention, and computerized tomography scanning findings according to the Marshall classification system. Only time between injury and arrival (p = 0.001) was statistically significant. There was a statistically significant difference in the proportions of good outcomes between the multimodality group compared with the group of patients that underwent a single intracranial-based monitoring method and the group that received no monitoring (p = 0.003) based on a disability rating scale after a follow up of 12 months. Death was the focus of outcome in this study in which the multimodality approach to monitoring had superior results.</jats:p>

Neurointensive Care Monitoring for Severe Traumatic Brain Injury

“…Death was the focus of outcome in this study in which the multimodality approach to monitoring had superior results (Isa et al, 2003). The subsequent studies done in our centre were prognostic and cost effectiveness analysis studies of using different monitoring modalities in treating severe traumatic brain injury which were completed in 2004 and published in 2007 Idris et al, 2007).…”

“…Currently, the assessment of intracranial status for severely injured brain is commonly done with gold standard ICP monitoring alone. Lately, as our understanding on the complex pathophysiology underlying severely injured brain expands, new modalities of brain monitoring emerge, incorporating various brain parameters known as the multimodality monitoring Isa et al, 2003;Stuart et al, 2010).…”

“…This is attained by using either ventricular catheter if the ventricles are opened or a compliance monitor (Spiegelberg GmbH & Co., Hamburg, Germany) or an intraparenchymal ICP, using Codman (Codman, Randolph, MA, USA) or Camino transducers (Camino Laboratories, San Diego, CA) Isa et al, 2003). If the ICP values persistently read more than 20 mmHg and/or direct calculation of cerebral perfusion pressure (CPP) appears less than 50 mmHg, draining of CSF is warranted.…”

“…Thus caution is needed in interpreting TCD data in its estimate of CBF. Abnormally low (ischaemic brain) or high (vasospasm or hyperaemic brain) FV must be interpreted carefully and preferably in conjunction with other CBF monitoring parameters Isa et al, 2003). is an effective method of measuring tissue cerebral oxygen tension (PtiO 2 ), along with carbon dioxide tissue levels (PtiCO 2 ), brain pH and brain temperature (Charbel et al, 1997).…”

Electric Versus Manual Tooth Brushing among Neuroscience ICU Patients: Is it Safe?

“…1 During the initial 72 hours after injury, cerebral edema evolves and can result in further neuronal deterioration. 2,3 To prevent secondary injury in such patients, staff must be attentive to trends in ICP and their patients' responses to bedside care, which can include agitation and undesirable fluctuations in blood pressure and tissue perfusion. The resulting intracranial hemodynamic decompensation may exacerbate increased ICP and cause further neurological deterioration.…”