Risk-benefit Analysis of Barbiturate Coma Therapy in Patients Who Received Decompressive Craniectomy for Malignant Cerebral Infarction

Joo, Myung Sung; Song, Sang Woo; Park, Dong Sun; Chun, Young Il; Koh, Young-Cho

doi:10.21129/nerve.2016.2.2.59

Cited by 1 publication

(2 citation statements)

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“…RICH can be controlled with high-dose barbiturate treatment [3–5,18]. However, almost all studies on BCT have evaluated patients with TBI and malignant infarction [4–6,25–27], and limited data are available on patients with brain tumor. In this study, ICPs after BCT were also significantly decreased as compared to ICPs before BCT in RICH patients undergoing tumor surgery.…”

Section: Discussionmentioning

confidence: 99%

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Early prediction of neurological outcome after barbiturate coma therapy in patients undergoing brain tumor surgery

Ryu¹,

Jung²,

Jung³

et al. 2019

PLoS ONE

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After a difficult brain tumor surgery, refractory intracranial hypertension (RICH) may occur due to residual tumor or post-operative complications such as hemorrhage, infarction, and aggravated brain edema. We investigated which predictors are associated with prognosis when using barbiturate coma therapy (BCT) as a second-tier therapy to control RICH after brain tumor surgery. The study included adult patients who underwent BCT after brain tumor surgery between January 2010 and December 2016. The primary outcome was neurological status upon hospital discharge, which was assessed using the Glasgow Outcome Scale (GOS). In the study period, 4,296 patients underwent brain tumor surgery in total. Of these patients, BCT was performed in 73 patients (1.7%). Among these 73 patients, 56 (76.7%) survived to discharge and 25 (34.2%) showed favorable neurological outcomes (GOS scores of 4 and 5). Invasive monitoring of intracranial pressure (ICP) was performed in 60 (82.2%) patients, and revealed that the maximal ICP within 6 h after BCT was significantly lower in patients with favorable neurological outcome as well as in survivors ( p = 0.008 and p = 0.028, respectively). Uncontrolled RICH (ICP ≥ 22 mm Hg within 6 h of BCT) was an important predictor of mortality after BCT (adjusted hazard ratio 12.91, 95% confidence interval [CI] 2.788–59.749), and in particular, ICP ≥ 15 mm Hg within 6 h of BCT was associated with poor neurological outcome (adjusted odds ratio 9.36, 95% CI 1.664–52.614). Therefore, early-controlled ICP after BCT was associated with clinical prognosis. There were no significant differences in the complications associated with BCT between the two neurological outcome groups. No BCT-induced death was observed. The active and timely control of RICH may be beneficial for clinical outcomes in patients with RICH after brain tumor surgery.

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Section: Discussionmentioning

confidence: 99%

“…A neurointensivist was involved in general critical management, including hemodynamic monitoring; nutritional support; and the use of mechanical ventilation, renal replacement therapy, etc [29]. Therefore, these factors might have led to the better clinical outcomes of BCT than those reported in previous studies [6,20,27,28].…”

Section: Discussionmentioning

confidence: 99%