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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Traumatic brain injury.Lancet. 2000; 356: 923-929
- The role of secondary brain injury in determining outcome from severe head injury.J Trauma. 1993; 34: 216-222
- Measuring the burden of secondary insults in head-injured patients during intensive care.J Neurosurg Anesthesiol. 1994; 6: 4-14
- The relation between acute physiological variables and outcome on the Glasgow Outcome Scale and Disability Rating Scale following severe traumatic brain injury.J Neurotrauma. 2001; 18: 115-125
- Fluid thresholds and outcome from severe brain injury.Crit Care Med. 2002; 30: 739-745
- Predicting recovery in patients suffering from traumatic brain injury by using admission variables and physiological data: a comparison between decision tree analysis and logistic regression.J Neurosurg. 2002; 97: 326-336
- Cerebral perfusion pressure management in head injury.J Trauma. 1990; 30 (discussion 940–1): 933-940
- The impact of ICP instability and hypotension on outcome in patients with severe head trauma.J Neurosurg. 1991; 75: 159-166
- Intracranial pressure monitoring in patients with severe head injury.Am Surg. 1982; 48: 477-480
- Determinants of mortality in patients with severe blunt head injury.Arch Surg. 2002; 137: 285-290
- Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds.J Neurotrauma. 2007; 24: S55-S58
- The oval pupil: clinical significance and relationship to intracranial hypertension.J Neurosurg. 1983; 58: 566-568
- Cerebral blood flow at constant cerebral perfusion pressure but changing arterial and intracranial pressure: relationship to autoregulation.J Neurosurg Anesthesiol. 1992; 4: 188-193
- Does an increase in cerebral perfusion pressure always mean a better oxygenated brain? A study in head-injured patients.Acta Neurochir Suppl. 2000; 76: 457-462
- 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
- Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma.J Neurosurg. 2005; 102: 311-317
- False autoregulation (pseudoautoregulation) in patients with severe head injury. Its importance in CPP management.Acta Neurochir Suppl. 2000; 76: 485-490
- Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury.J Neurosurg. 2001; 95: 560-568
Article info
Publication history
Published online: January 21, 2014
Received in revised form:
September 21,
2013
Received:
August 31,
2013
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
