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Intracranial pressure versus cerebral perfusion pressure as a marker of outcomes in severe head injury: a prospective evaluation

  • Efstathios Karamanos
    Correspondence
    Corresponding author. Tel.: +1-323-696-5570; fax: +1-323-441-9001.
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery, and Surgical Critical Care), University of Southern California—Keck School of Medicine, Los Angeles County General Hospital (LAC + USC), 2051 Marengo Street, C5L100, Los Angeles, CA 90033-4525, USA
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  • Pedro G. Teixeira
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery, and Surgical Critical Care), University of Southern California—Keck School of Medicine, Los Angeles County General Hospital (LAC + USC), 2051 Marengo Street, C5L100, Los Angeles, CA 90033-4525, USA
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  • Emre Sivrikoz
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery, and Surgical Critical Care), University of Southern California—Keck School of Medicine, Los Angeles County General Hospital (LAC + USC), 2051 Marengo Street, C5L100, Los Angeles, CA 90033-4525, USA
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  • Stephen Varga
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery, and Surgical Critical Care), University of Southern California—Keck School of Medicine, Los Angeles County General Hospital (LAC + USC), 2051 Marengo Street, C5L100, Los Angeles, CA 90033-4525, USA
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  • Konstantinos Chouliaras
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery, and Surgical Critical Care), University of Southern California—Keck School of Medicine, Los Angeles County General Hospital (LAC + USC), 2051 Marengo Street, C5L100, Los Angeles, CA 90033-4525, USA
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  • Obi Okoye
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery, and Surgical Critical Care), University of Southern California—Keck School of Medicine, Los Angeles County General Hospital (LAC + USC), 2051 Marengo Street, C5L100, Los Angeles, CA 90033-4525, USA
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  • Peter Hammer
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery, and Surgical Critical Care), University of Southern California—Keck School of Medicine, Los Angeles County General Hospital (LAC + USC), 2051 Marengo Street, C5L100, Los Angeles, CA 90033-4525, USA
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Published:January 21, 2014DOI:https://doi.org/10.1016/j.amjsurg.2013.10.026

      Abstract

      Background

      Intracranial pressure (ICP) monitoring is a standard of care in severe traumatic brain injury when clinical features are unreliable. It remains unclear, however, whether elevated ICP or decreased cerebral perfusion pressure (CPP) predicts outcome.

      Methods

      This is a prospective observational study of patients sustaining severe blunt head injury, admitted to the surgical intensive care unit at the Los Angeles County and University of Southern California Medical Center between January 2010 and December 2011. The study population was stratified according to the findings of ICP and CPP. Primary outcomes were overall in-hospital mortality and mortality because of cerebral herniation. Secondary outcomes were development of complications during the hospitalization.

      Results

      A total of 216 patients met Brain Trauma Foundation guidelines for ICP monitoring. Of those, 46.8% (n = 101) were subjected to the intervention. Sustained elevated ICP significantly increased all in-hospital mortality (adjusted odds ratio [95% confidence interval]: 3.15 [1.11, 8.91], P = .031) and death because of cerebral herniation (adjusted odds ratio [95% confidence interval]: 9.25 [1.19, 10.48], P = .035). Decreased CPP had no impact on mortality.

      Conclusions

      A single episode of sustained increased ICP is an accurate predictor of poor outcomes. Decreased CPP did not affect survival.

      Keywords

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