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Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study.

You W, Feng J, Tang Q, Cao J, Wang L, Lei J, Mao Q, Gao G, Jiang J - BMC Anesthesiol (2016)

Bottom Line: The primary outcome was in-hospital mortality.The total length of hospital stay did not differ between the two groups (28.5 ± 12.1 days vs 26.1 ± 13.5 days, P = 0.23).Intraventricular ICP monitoring may have beneficial effects on the decreased in-hospital mortality and improved 6-month outcome of older patients with severe TBI.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China.

ABSTRACT

Background: Intracranial pressure (ICP) monitoring is widely used in the management of patients with severe traumatic brain injury (TBI). However, there is limited evidence about the efficacy of ICP monitoring in older subjects (aged ≥65 years). This study evaluated the effect of intraventricular ICP monitoring on the outcome of older adults suffering from a severe TBI.

Methods: This prospective, observational study included 166 older TBI patients (aged ≥65 years) with Glasgow Coma scale (GCS) scores lower than 9 at admission. The study cohort was divided into two groups, intraventricular ICP monitoring and non-ICP monitoring. The primary outcome was in-hospital mortality. The secondary outcomes included the Glasgow Outcome Scale (GOS) score 6 months after injury, the ICU and total hospital lengths of stay, and mechanical ventilation days.

Results: There were 80 patients in the intraventricular ICP monitoring group and 86 patients in non-ICP monitoring group. There was no statistical difference between groups in demographics and severity of head injury. Patients treated with intraventricular ICP monitoring had lower in-hospital mortality (33.8 % vs 51.2 %, P < 0.05), a higher 6-month GOS score (3.0 ± 1.4 vs 2.5 ± 1.2 P < 0.05), and a lower dosage (514 ± 246 g vs 840 ± 323 g, P < 0.0001) and shorter duration (7.2 ± 3.6 days vs 8.4 ± 4.3 days, P < 0.01) of mannitol use. However, the ICU length of stay (14.3 ± 6.4 days vs 11.6 ± 5.8 days, P < 0.01) and mechanical ventilation days (6.7 ± 3.5 days vs 5.6 ± 2.4 days, P < 0.05) were longer in the ICP monitoring group. The total length of hospital stay did not differ between the two groups (28.5 ± 12.1 days vs 26.1 ± 13.5 days, P = 0.23).

Conclusions: Intraventricular ICP monitoring may have beneficial effects on the decreased in-hospital mortality and improved 6-month outcome of older patients with severe TBI. However, given that this was an observational study conducted in a single institution, further well-designed randomized control trials are needed to evaluate the effect of intraventricular ICP monitoring on the outcome of older severe TBI patients.

No MeSH data available.


Related in: MedlinePlus

Flowchart of patient screening and study inclusion. TBI = traumatic brain injury; ICP = intracranial pressure monitoring
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Fig1: Flowchart of patient screening and study inclusion. TBI = traumatic brain injury; ICP = intracranial pressure monitoring

Mentions: A total of 166 patients (aged ≥65 years) with a severe TBI, admitted to the neurosurgical department of the study hospital between January 2008 and June 2014, were enrolled in our study. Eighty patients received treatment with intraventricular ICP monitoring and 86 patients were treated without ICP monitoring (Fig. 1). The demographic and clinical characteristics of both groups are summarized in Table 1. Falls were the leading cause of head injury in both groups (53.8 and 55.8 %, respectively), followed by traffic accidents (30 and 32.6 %, respectively). The proportions of females in both groups (57.5 and 60.5 %, respectively) were higher than for males (42.5 and 39.5 %, respectively). With regard to CT findings, patients who sustained a Marshall CT classification of II were more likely to receive treatment without ICP monitoring (16.3 % vs 31.4 %, P < 0.05). Age, gender, comorbidities, GCS at admission, mechanism of head injury, ISS, and AIS of the head did not differ significantly between the study groups.Fig. 1


Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study.

You W, Feng J, Tang Q, Cao J, Wang L, Lei J, Mao Q, Gao G, Jiang J - BMC Anesthesiol (2016)

Flowchart of patient screening and study inclusion. TBI = traumatic brain injury; ICP = intracranial pressure monitoring
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940906&req=5

Fig1: Flowchart of patient screening and study inclusion. TBI = traumatic brain injury; ICP = intracranial pressure monitoring
Mentions: A total of 166 patients (aged ≥65 years) with a severe TBI, admitted to the neurosurgical department of the study hospital between January 2008 and June 2014, were enrolled in our study. Eighty patients received treatment with intraventricular ICP monitoring and 86 patients were treated without ICP monitoring (Fig. 1). The demographic and clinical characteristics of both groups are summarized in Table 1. Falls were the leading cause of head injury in both groups (53.8 and 55.8 %, respectively), followed by traffic accidents (30 and 32.6 %, respectively). The proportions of females in both groups (57.5 and 60.5 %, respectively) were higher than for males (42.5 and 39.5 %, respectively). With regard to CT findings, patients who sustained a Marshall CT classification of II were more likely to receive treatment without ICP monitoring (16.3 % vs 31.4 %, P < 0.05). Age, gender, comorbidities, GCS at admission, mechanism of head injury, ISS, and AIS of the head did not differ significantly between the study groups.Fig. 1

Bottom Line: The primary outcome was in-hospital mortality.The total length of hospital stay did not differ between the two groups (28.5 ± 12.1 days vs 26.1 ± 13.5 days, P = 0.23).Intraventricular ICP monitoring may have beneficial effects on the decreased in-hospital mortality and improved 6-month outcome of older patients with severe TBI.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China.

ABSTRACT

Background: Intracranial pressure (ICP) monitoring is widely used in the management of patients with severe traumatic brain injury (TBI). However, there is limited evidence about the efficacy of ICP monitoring in older subjects (aged ≥65 years). This study evaluated the effect of intraventricular ICP monitoring on the outcome of older adults suffering from a severe TBI.

Methods: This prospective, observational study included 166 older TBI patients (aged ≥65 years) with Glasgow Coma scale (GCS) scores lower than 9 at admission. The study cohort was divided into two groups, intraventricular ICP monitoring and non-ICP monitoring. The primary outcome was in-hospital mortality. The secondary outcomes included the Glasgow Outcome Scale (GOS) score 6 months after injury, the ICU and total hospital lengths of stay, and mechanical ventilation days.

Results: There were 80 patients in the intraventricular ICP monitoring group and 86 patients in non-ICP monitoring group. There was no statistical difference between groups in demographics and severity of head injury. Patients treated with intraventricular ICP monitoring had lower in-hospital mortality (33.8 % vs 51.2 %, P < 0.05), a higher 6-month GOS score (3.0 ± 1.4 vs 2.5 ± 1.2 P < 0.05), and a lower dosage (514 ± 246 g vs 840 ± 323 g, P < 0.0001) and shorter duration (7.2 ± 3.6 days vs 8.4 ± 4.3 days, P < 0.01) of mannitol use. However, the ICU length of stay (14.3 ± 6.4 days vs 11.6 ± 5.8 days, P < 0.01) and mechanical ventilation days (6.7 ± 3.5 days vs 5.6 ± 2.4 days, P < 0.05) were longer in the ICP monitoring group. The total length of hospital stay did not differ between the two groups (28.5 ± 12.1 days vs 26.1 ± 13.5 days, P = 0.23).

Conclusions: Intraventricular ICP monitoring may have beneficial effects on the decreased in-hospital mortality and improved 6-month outcome of older patients with severe TBI. However, given that this was an observational study conducted in a single institution, further well-designed randomized control trials are needed to evaluate the effect of intraventricular ICP monitoring on the outcome of older severe TBI patients.

No MeSH data available.


Related in: MedlinePlus