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Critical ICP thresholds in relation to outcome: Is 22 mmHg really the answer?
Riparbelli, Agnes C; Capion, Tenna; Møller, Kirsten; Mathiesen, Tiit I; Olsen, Markus H; Forsse, Axel.
Afiliación
  • Riparbelli AC; Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. agnes.crj@gmail.com.
  • Capion T; Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
  • Møller K; Department of Neuroanesthesiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
  • Mathiesen TI; Department of Clinical Medicine, Faculty of Health and Medical Sciences SUND, University of Copenhagen, Copenhagen, Denmark.
  • Olsen MH; Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
  • Forsse A; Department of Clinical Medicine, Faculty of Health and Medical Sciences SUND, University of Copenhagen, Copenhagen, Denmark.
Acta Neurochir (Wien) ; 166(1): 63, 2024 Feb 05.
Article en En | MEDLINE | ID: mdl-38315234
ABSTRACT

PURPOSE:

Intensive care for patients with traumatic brain injury (TBI) aims, among other tasks, at avoiding high intracranial pressure (ICP), which is perceived to worsen motor and cognitive deficits and increase mortality. International recommendations for threshold values for ICP were increased from 20 to 22 mmHg in 2016 following the findings in a study by Sorrentino et al., which were based on an observational study of patients with TBI of averaged ICP values. We aimed to reproduce their approach and validate the findings in a separate cohort.

METHODS:

Three hundred thirty-one patients with TBI were included and categorised according to survival/death and favourable/unfavourable outcome at 6 months (based on Glasgow Outcome Score-Extended of 6-8 and 1-5, respectively). Repeated chi-square tests of survival and death (or favourable and unfavourable outcome) vs. high and low ICP were conducted with discrimination between high and low ICP sets at increasing values (integers) between 10 and 35 mmHg, using the average ICP for the entire monitoring period. The ICP limit returning the highest chi-square score was assumed to be the threshold with best discriminative ability. This approach was repeated after stratification by sex, age, and initial Glasgow Coma Score (GCS).

RESULTS:

An ICP limit of 18 mmHg was found for both mortality and unfavourable outcome for the entire cohort. The female and the low GCS subgroups both had threshold values of 18 mmHg; for all other subgroups, the threshold varied between 16 and 30 mmHg. According to a multiple logistic regression analysis, age, initial GCS, and average ICP are independently associated with mortality and outcome.

CONCLUSIONS:

Using identical methods and closely comparable cohorts, the critical thresholds for ICP found in the study by Sorrentino et al. could not be reproduced.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Presión Intracraneal / Lesiones Traumáticas del Encéfalo Tipo de estudio: Diagnostic_studies / Observational_studies Límite: Female / Humans Idioma: En Revista: Acta Neurochir (Wien) Año: 2024 Tipo del documento: Article País de afiliación: Dinamarca Pais de publicación: Austria
Texto completo
Añadir a Mi BVS
Imprimir
XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Presión Intracraneal / Lesiones Traumáticas del Encéfalo Tipo de estudio: Diagnostic_studies / Observational_studies Límite: Female / Humans Idioma: En Revista: Acta Neurochir (Wien) Año: 2024 Tipo del documento: Article País de afiliación: Dinamarca Pais de publicación: Austria