Highlighting intracranial pressure monitoring in patients with severe acute brain trauma

Falcão, Antonio L. E; Dantas Filho, Venâncio P.; Sardinha, Luiz A. C.; Quagliato, Elizabeth M. A. B.; Dragosavac, Desanka; Araújo, Sebastião; Terzi, Renato G. G.

doi:10.1590/S0004-282X1995000300004

Abstracts

Intracranial pressure (ICP) monitoring was carried out in 100 patients with severe acute brain trauma, primarily by means of a subarachnoid catheter. Statistical associations were evaluated between maximum ICP values and: 1) Glasgow Coma Scale (GCS) scores; 2) findings on computed tomography (CT) scans of the head; and 3) mortality. A significant association was found between low GCS scores (3 to 5) and high ICP levels, as well as between focal lesions on CT scans and elevated ICP. Mortality was significantly higher in patients with ICP > 40 mm Hg than in those with ICP < 20 mm Hg.

head injury; intracranial pressure; coma

Monitorização da pressão intracraniana (PIC) foi adotada em 100 pacientes com traumatismo cerebral agudo grave, usando-se preferencialmente um catéter subaracnóide. Associações estatísticas foram avaliadas entre valores máximos de PIC e : 1) número de pontos na Escala de Coma de Glasgow (ECG); 2) achados na tomografia computadorizada (TC) da cabeça; e 3) mortalidade. Encontrou-se associação significante entre baixo número de pontos (3 a 5) na ECG e PIC elevada, assim como entre lesões focais na TC e hipertensão intracraniana. A mortalidade foi significantemente maior em pacientes com PIC > 40 mm Hg do que naqueles com PIC < 20 mm Hg.

traumatismo cerebral; pressão intracraniana; coma

Antonio L. E Falcão^I; Venâncio P. Dantas Filho^I; Luiz A. C. Sardinha^I; Elizabeth M. A. B. Quagliato^II; Desanka Dragosavac^I; Sebastião Araújo^I; Renato G. G. Terzi^I

^IIntensive Care Unit and Department of Neurology

^IIHospital das Clinicas, Universidade Estadual de Campinas (UNICAMP), São Paulo

SUMMARY

Intracranial pressure (ICP) monitoring was carried out in 100 patients with severe acute brain trauma, primarily by means of a subarachnoid catheter. Statistical associations were evaluated between maximum ICP values and: 1) Glasgow Coma Scale (GCS) scores; 2) findings on computed tomography (CT) scans of the head; and 3) mortality. A significant association was found between low GCS scores (3 to 5) and high ICP levels, as well as between focal lesions on CT scans and elevated ICP. Mortality was significantly higher in patients with ICP > 40 mm Hg than in those with ICP < 20 mm Hg.

Key words:head injury, intracranial pressure, coma.

RESUMO

Monitorização da pressão intracraniana (PIC) foi adotada em 100 pacientes com traumatismo cerebral agudo grave, usando-se preferencialmente um catéter subaracnóide. Associações estatísticas foram avaliadas entre valores máximos de PIC e : 1) número de pontos na Escala de Coma de Glasgow (ECG); 2) achados na tomografia computadorizada (TC) da cabeça; e 3) mortalidade. Encontrou-se associação significante entre baixo número de pontos (3 a 5) na ECG e PIC elevada, assim como entre lesões focais na TC e hipertensão intracraniana. A mortalidade foi significantemente maior em pacientes com PIC > 40 mm Hg do que naqueles com PIC < 20 mm Hg.

Palavras-chave: traumatismo cerebral, pressão intracraniana, coma.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 22-fevereiro-1995.

Dr. Antonio L. E. Falcão - Rua Dr. Lauro Pimentel 195 - Cidade Universitária, UNICAMP -13083-250 Campinas SP - Brasil.

1. Colli BO, Falcão ALE, Dantas VP Filho. [Intracranial hypertension - monitoring and treatment]. In Terzi RGG, Araújo S (eds). Técnicas Básicas em UTI. São Paulo: Manole, 1992, p 401-417 (Port).
2. Cruz J. On-line monitoring of global cerebral hypoxia in acute brain injury: relationship to intracranial hypertension. J Neurosurg 1993, 79:228-233.
3. Cruz J, Jaggi JL, Hoffstad OJ. Cerebral blood flow and oxygen consumption in acute brain injury with acute anemia: An alternative for the cerebral metabolic rate of oxygen consumption ? Crit Care Med 1993, 21:1218-1224.
4. Cruz J. Combined continuous monitoring of systemic and cerebral oxygenation in acute brain injury: Preliminary observations. Crit Care Med 1993, 21:1225-1232.
5. Cruz J. An additional therapeutic effect of adequate hyperventilation in severe acute brain trauma: normalization of cerebral glucose uptake. J Neurosurg 1995, 82:379-385.
6. Dearden NM. Brain edema and raised intracranial pressure after head injury. In Vincent JL (ed). Yearbook of intensive care and emergency medicine. Berlin: Springer-Verlag, 1992, p 537-552.
7. Dickman CA, Carter P, Baldwin HZ, Harrington T, Tallman D. Continuous regional cerebral blood flow monitoring in acute craniocerebral trauma. Neurosurgery 1991, 28:467-472.
8. Falcão ALE, Dantas VP Filho, Saraiva JFK, Sardinha LAC, Araújo S, Terzi RGG. Bedside ICP monitoring in head trauma patients by using a simple, safe and low cost methodology (Abstr). Clin Int Care 1992, (Suppl) 3:112.
9. Fishman RA. Brain edema. N Engl J Med 1975, 393:706-711.
10. Guillaume J, Janny P. Manometrie intracrânienne continue: intérêt de la méthode et premiers résultats. Rev Neurol 1951, 84:131-142.
11. Lundberg N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand 1960, (Suppl 149) 36:1-193.
12. Marmarou A, Anderson RL, Ward JD, Choi SC, Young HF, Eisenberg HM, Foulkes MA, Marshall LF, Jane JA. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 1991, (Suppl) 75:S59-S66.
13. Marshall LF, Smith RW, Shapiro HM. The outcome with aggressive treatment in severe head injuries. Part 1: The significance of intracranial pressure monitoring. J Neurosurg 1979, 50:20-25.
14. McGillicuddy JE. Cerebral protection, pathophysiology and treatment of increased intracranial pressure. Chest 1985, 87:85-93.
15. Miller JD. ICP monitoring: current status and future directions. Acta Neurochir 1987, 85:80-86.
16. Mollman HD, Rockswold GL, Ford SE. A clinical comparison of subarachnoid catheters to ventriculostomy and subarachnoid bolts: a prospective study. J Neurosurg 1988, 68:737-741.
17. Obrist WD, Langfitt TW, Jaggi JL, Cruz J, Gennarelli TA. Cerebral blood flow and metabolism in comatose patients with acute head injury: relationship to intracranial hypertension. J Neurosurg 1984, 61:241-253.
18. Rosner MJ, Daughton S. Cerebral perfusion pressure management in head injury. J Trauma 1990, 30:933-941.
19. Stuart GG, Merry GS, Smith JA, Yelland DN. Severe head injury managed without intracranial pressure monitoring. J Neurosurg 1983, 59:601-605.
20. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet 1974, 2:81-84.
21. Yano M, Kobayashi S, Otsuka T. Useful ICP monitoring with subarachnoid catheter method in severe head injuries. J Trauma 1988, 28:476-480.

Highlighting intracranial pressure monitoring in patients with severe acute brain trauma

Ressaltando a monitorização da pressão intracraniana em pacientes com traumatismo cerebral agudo grave

Publication Dates

Publication in this collection
09 Dec 2010
Date of issue
Sept 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Colli BO, Falcão ALE, Dantas VP Filho. [Intracranial hypertension - monitoring and treatment]. In Terzi RGG, Araújo S (eds). Técnicas Básicas em UTI. São Paulo: Manole, 1992, p 401-417 (Port).

[2] 2. Cruz J. On-line monitoring of global cerebral hypoxia in acute brain injury: relationship to intracranial hypertension. J Neurosurg 1993, 79:228-233.

[3] 3. Cruz J, Jaggi JL, Hoffstad OJ. Cerebral blood flow and oxygen consumption in acute brain injury with acute anemia: An alternative for the cerebral metabolic rate of oxygen consumption ? Crit Care Med 1993, 21:1218-1224.

[4] 4. Cruz J. Combined continuous monitoring of systemic and cerebral oxygenation in acute brain injury: Preliminary observations. Crit Care Med 1993, 21:1225-1232.

[5] 5. Cruz J. An additional therapeutic effect of adequate hyperventilation in severe acute brain trauma: normalization of cerebral glucose uptake. J Neurosurg 1995, 82:379-385.

[6] 6. Dearden NM. Brain edema and raised intracranial pressure after head injury. In Vincent JL (ed). Yearbook of intensive care and emergency medicine. Berlin: Springer-Verlag, 1992, p 537-552.

[7] 7. Dickman CA, Carter P, Baldwin HZ, Harrington T, Tallman D. Continuous regional cerebral blood flow monitoring in acute craniocerebral trauma. Neurosurgery 1991, 28:467-472.

[8] 8. Falcão ALE, Dantas VP Filho, Saraiva JFK, Sardinha LAC, Araújo S, Terzi RGG. Bedside ICP monitoring in head trauma patients by using a simple, safe and low cost methodology (Abstr). Clin Int Care 1992, (Suppl) 3:112.

[9] 9. Fishman RA. Brain edema. N Engl J Med 1975, 393:706-711.

[10] 10. Guillaume J, Janny P. Manometrie intracrânienne continue: intérêt de la méthode et premiers résultats. Rev Neurol 1951, 84:131-142.

[11] 11. Lundberg N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand 1960, (Suppl 149) 36:1-193.

[12] 12. Marmarou A, Anderson RL, Ward JD, Choi SC, Young HF, Eisenberg HM, Foulkes MA, Marshall LF, Jane JA. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 1991, (Suppl) 75:S59-S66.

[13] 13. Marshall LF, Smith RW, Shapiro HM. The outcome with aggressive treatment in severe head injuries. Part 1: The significance of intracranial pressure monitoring. J Neurosurg 1979, 50:20-25.

[14] 14. McGillicuddy JE. Cerebral protection, pathophysiology and treatment of increased intracranial pressure. Chest 1985, 87:85-93.

[15] 15. Miller JD. ICP monitoring: current status and future directions. Acta Neurochir 1987, 85:80-86.

[16] 16. Mollman HD, Rockswold GL, Ford SE. A clinical comparison of subarachnoid catheters to ventriculostomy and subarachnoid bolts: a prospective study. J Neurosurg 1988, 68:737-741.

[17] 17. Obrist WD, Langfitt TW, Jaggi JL, Cruz J, Gennarelli TA. Cerebral blood flow and metabolism in comatose patients with acute head injury: relationship to intracranial hypertension. J Neurosurg 1984, 61:241-253.

[18] 18. Rosner MJ, Daughton S. Cerebral perfusion pressure management in head injury. J Trauma 1990, 30:933-941.

[19] 19. Stuart GG, Merry GS, Smith JA, Yelland DN. Severe head injury managed without intracranial pressure monitoring. J Neurosurg 1983, 59:601-605.

[20] 20. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet 1974, 2:81-84.

[21] 21. Yano M, Kobayashi S, Otsuka T. Useful ICP monitoring with subarachnoid catheter method in severe head injuries. J Trauma 1988, 28:476-480.