Role of Intracranial Pressure Monitoring in Management of Patients with Severe Traumatic Brain Injury: Results of a Large Level I Trauma Center in Southern Iran

Autor: Hosseinali Khalili, Amin Sadraei, Fariborz Ghaffarpasand, Amin Niakan, Nazanin Sadraei
Rok vydání: 2016
Předmět:
Male
Intracranial Pressure
medicine.medical_treatment
Glasgow Outcome Scale
Iran
Ventriculostomy
Cohort Studies
0302 clinical medicine
Injury Severity Score
Trauma Centers
Brain Injuries
Traumatic
Medicine
030212 general & internal medicine
Prospective Studies
Intracranial pressure
Trauma center
Accidents
Traffic
Age Factors
Disease Management
Middle Aged
Prognosis
Anesthesia
Cerebrovascular Circulation
Intracranial pressure monitoring
Decompressive craniectomy
Female
medicine.symptom
Adult
Decompressive Craniectomy
Adolescent
Traumatic brain injury
Violence
03 medical and health sciences
Young Adult
Humans
Glasgow Coma Scale
Monitoring
Physiologic
Coma
business.industry
medicine.disease
Logistic Models
Multivariate Analysis
Surgery
Accidental Falls
Neurology (clinical)
Intracranial Hypertension
business
Tomography
X-Ray Computed
030217 neurology & neurosurgery
Zdroj: World neurosurgery. 94
ISSN: 1878-8769
Popis: To determine the role of intracranial pressure (ICP) monitoring in management of patients with severe traumatic brain injury (TBI) admitted to a large level I trauma center in Southern Iran.This was a cohort study performed during a 2-year period in a level I trauma center in Southern Iran including all adult patients (16 years) with severe TBI (Glasgow Coma Scale [GCS] score, 3-8) who underwent ICP monitoring through ventriculostomy. The management was based on the recorded ICP values with threshold of 20 mm Hg. Decompressive craniectomy was performed in patients with intractable intracranial hypertension (persistent ICP ≥25 mm Hg). In unresponsive patients, barbiturate coma was induced. Patients were followed for 6 months and Glasgow Outcome Scale Extended was recorded. The determinants of favorable and unfavorable outcome were also determined.Overall, we included 248 patients with mean age of 34.6 ± 16.6 years, among whom there were 216 men (87.1%) and 32 women (12.9%). Eighty-five patients (34.2%) had favorable and 163 (65.8%) unfavorable outcomes. Those with favorable outcome had significantly lower age (P = 0.004), higher GCS score on admission (P0.001), lower Rotterdam score (P = 0.035), fewer episodes of intracranial hypertension (P0.001), and lower maximum recorded ICP (P = 0.041). These factors remained statistically significant after elimination of confounders by multivariate logistic regression model.Age, GCS score on admission, Rotterdam score, intracranial hypertension, and maximum recorded ICP are important determinants of outcome in patients with severe TBI. ICP monitoring assisted us in targeted therapy and management of patients with severe TBI.
Databáze: OpenAIRE
Externí odkaz: