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Timing of intracranial hypertension following severe traumatic brain injury

Deborah M Stein1, Megan Brenner, Peter F Hu

  • 1Program in Trauma, Division of Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA. dstein@umm.edu

Neurocritical Care
|March 16, 2013
PubMed

Insights

Continuous intracranial pressure (ICP) monitoring reveals that intracranial hypertension (ICH) is highest later in the hospital course. Later ICH predicts poor functional outcomes in neurotrauma patients.

Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Trauma Surgery

Background:

  • Continuous intracranial pressure (ICP) monitoring is crucial for assessing intracranial hypertension (ICH) in neurotrauma.
  • Understanding the temporal dynamics of ICH and its link to patient outcomes is vital for effective management.

Purpose of the Study:

  • To determine if continuous ICP data can objectively measure the degree and timing of ICH in the first week post-neurotrauma.
  • To investigate the association between ICP monitoring data and patient functional outcomes.

Main Methods:

  • Adult patients with severe traumatic brain injury (TBI) were enrolled within 6 hours of admission.
  • ICP data were captured continuously, with 5-minute means analyzed in 12-hour intervals.
  • Metrics including mean ICP, maximum ICP, percent time of elevated ICP (%time), and pressure-times-time dose (PTD) were calculated for ICP >20 mmHg and >30 mmHg.

Main Results:

  • 191 patients were enrolled; only 2.1% had no ICH episodes.
  • Intracranial hypertension metrics (PTD, %time) were significantly higher in the later hospital period (84-180 hours) compared to the early period (0-84 hours).
  • Increased PTD after 84 hours independently predicted a higher likelihood of poor functional outcome (aOR=1.21).

Conclusions:

  • Intracranial pressure elevations are often highest later in the hospital course than previously recognized.
  • Temporal patterns of ICP elevation, particularly later in the course, are significantly associated with functional outcomes.
  • Recognizing the temporal nature of secondary insults like ICH has critical implications for neurotrauma patient management.
Abstract

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