Abstract
Introduction
Raised intracranial pressure (ICP) has been consistently associated with poor neurological outcome. Our purpose was to systematically review the literature to estimate the association between ICP values and patterns and short- and long-term vital and neurological outcome.
Methods
Systematic review of studies identified from MEDLINE, EMBASE, and COCHRANE Registry search from 1966 to 2005, and reference lists of identified articles, with independent assessment of methodological quality, population, ICP values and patterns, management of raised ICP and neurological outcomes. Summary odds ratios (OR) were calculated for the main outcomes using proportional odds models and logistic regression.
Results
Four prospective studies (409 patients) reported the effect of ICP values, and five studies (677 patients) reported the effect of ICP patterns on neurological outcome. No study reported neurological outcomes beyond 1 year. Relative to normal ICP (<20 mmHg), raised ICP was associated with elevated OR of death: 3.5 [95%CI: 1.7, 7.3] for ICP 20–40, and 6.9 [95%CI: 3.9, 12.4] for ICP >40. Raised but reducible ICP was associated with a 3–4-fold increase in the OR of death or poor neurological outcome. Refractory ICP pattern was associated with a dramatic increase in the relative risk of death (OR 114.3 [95%CI: 40.5, 322.3]).
Conclusions
Refractory ICP and response to treatment of raised ICP could be better predictors of neurological outcome than absolute ICP values. Limitations in the design of the studies analyzed precluded identification of the role of ICP monitoring in predicting short- and long-term outcomes.
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References
Sosin DM, Sniezek JE, Waxweiler RJ. Trends in death associated with traumatic brain injury, 1979 through 1992. Success and failure. JAMA 1995;273:1778–80.
Adekoya N, Thurman DJ, White DD, et␣al. Surveillance for traumatic brain injury deaths—United States, 1989–1998. MMWR Surveill Summ 2002;51:1–14.
The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Hyperventilation. J Neurotrauma 2000;17:513–20.
The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Use of mannitol. J Neurotrauma 2000;17:521–5.
Fowler S. Mild hypothermia for severely head-injured patients with low intracranial pressure (ICP). J Neurosci Nurs 1999;31:370.
Roberts I. Barbiturates for acute traumatic brain injury. Cochrane Database Syst Rev 2000:CD000033.
Biestro A, Barrios E, Baraibar J, et␣al. Use of vasopressors to raise cerebral perfusion pressure in head injured patients. Acta Neurochir Suppl (Wien) 1998;71:5–9.
The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Indications for intracranial pressure monitoring. J␣Neurotrauma 2000;17:479–91.
Becker DP, Miller JD, Ward JD, et␣al. The outcome from severe head injury with early diagnosis and intensive management. J␣Neurosurg 1977;47:491–502.
Johnston IH, Johnston JA, Jennett B. Intracranial-pressure changes following head injury. Lancet 1970;2:433–6.
Lundberg N, Troupp H, Lorin H. Continuous recording of the ventricular-fluid pressure in patients with severe acute traumatic brain injury. A preliminary report. J Neurosurg 1965;22:581–90.
Miller JD, Butterworth JF, Gudeman SK, et␣al. Further experience in the management of severe head injury. J Neurosurg 1981;54:289.
Narayan RK, Greenberg RP, Miller JD, et␣al. Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg 1981;54:751.
Troupp J. Intraventricular pressure in patients with severe brain injuries. J Trauma 1965;29:373–8.
Cremer OL, van Dijk GW, van Wensen E, et␣al. Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med 2005;33:2207–13.
Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975;1:480–4.
McCullagh P, Nelder JA. Chapter 5. In: generalized linear models. 2nd ed. London: Chapman and Hall; 1989.
Miller JD, Becker DP, Ward JD, et␣al. Significance of intracranial hypertension in severe head injury. J Neurosurg 1977;47:503–16.
Marshall LF, Smith RW, Shapiro HM. The outcome with aggressive treatment in severe head injuries. Part II: acute and chronic barbiturate administration in the management of head injury. J Neurosurg 1979;50:26–30.
Kobayashi S, Nakazawa S, Yano M, et␣al. The value of intracranial pressure (ICP) measurement in acute severe head injury showing diffuse cerebral swelling. In: Ishii S, Nagai H, Brock M (eds) Intracranial Pressure V. Berlin-Heidelberg-New York: Springer-Verlag; 1983.
Tsutsumi H, Ide K, Mizutani T, et␣al. The relationship between intracranial pressure, cerebral perfusion pressure and outcome in head-injured patients: the critical level of cerebral perfusion pressure. In: Miller JD, Teadsdale GM, Rowan JO et␣al.,editors. Intracranial Pressure VI. Berlin-Heidelberg-New York: Springer-Verlag; 1986. p. 661–6.
Narayan RK, Kishore PR, Becker DP, et␣al. Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg 1982;56:650–9.
Ng I, Lew TW, Yeo TT, et␣al. Outcome of patients with traumatic brain injury managed on a standardised head injury protocol. Ann Acad Med Singapore 1998;27:332–9.
Marmarou A, Saad A, Aygok G, et␣al. Contribution of raised ICP and hypotension to CPP reduction in severe brain injury: correlation to outcome. Acta Neurochir Suppl 2005;95:277–80.
Chesnut RM, Marshall LF, Klauber MR, et␣al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993;34:216–22.
Connors AF Jr, Speroff T, Dawson NV, et␣al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA 1996;276:889–97.
Muizelaar JP, Marmarou A, Ward JD, et␣al. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg 1991;75:731–39.
Kaufmann AM, Cardoso ER. Aggravation of vasogenic cerebral edema by multiple-dose mannitol. J Neurosurg 1992;77:584–89.
Rosner MJ, Rosner SD, Johnson AH. Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 1995;83:949–62.
Saul TG, Ducker TB. Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg 1982;56:498–503.
Smith HP, Kelly DL Jr, McWhorter JM, et␣al. Comparison of mannitol regimens in patients with severe head injury undergoing intracranial monitoring. J Neurosurg 1986;65:820–24.
Alberico AM, Ward JD, Choi SC, et␣al. Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg 1987;67:648–56.
Marmarou A, Anderson RL, Ward JD, et␣al. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 1991;75:s59–66.
Juul N, Morris GF, Marshall SB, et␣al. Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial. J Neurosurg 2000;92:1–6.
Clifton GL, Miller ER, Choi SC, et␣al. Fluid thresholds and outcome from severe brain injury. Crit Care Med 2002;30:739–45.
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Treggiari, M.M., Schutz, N., Yanez, N.D. et al. Role of intracranial pressure values and patterns in predicting outcome in traumatic brain injury: a systematic review. Neurocrit Care 6, 104–112 (2007). https://doi.org/10.1007/s12028-007-0012-1
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DOI: https://doi.org/10.1007/s12028-007-0012-1