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Published on: October 17, 2017
[Monitoring intracranial pressure in severe traumatic brain injury]
José Ramón García-Lira1, Rita Esther Zapata-Vázquez2, Felipe Alonzo-Vázquez1
1Facultad de Medicina, Universidad Autónoma de Yucatán, Mérida, Yucatán, México.
Insights
Intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI) cases showed increased mortality but good outcomes for survivors. Further trials are needed to confirm ICP monitoring
Area of Science:
- Pediatric neurosurgery
- Critical care medicine
- Trauma surgery
Background:
- Severe traumatic brain injury (TBI) poses significant challenges, particularly in resource-limited settings where intracranial pressure (ICP) monitoring is less accessible.
- ICP monitoring is a crucial tool for guiding treatment in severe TBI cases.
Purpose of the Study:
- To document the clinical experience with severe TBI in pediatric patients.
- To evaluate the impact of ICP monitoring on patient outcomes.
Main Methods:
- A cohort of pediatric patients (ages 1-17) with severe TBI was studied.
- Patients were divided into groups with and without ICP monitoring (using a 3PN Spiegelberg catheter).
- Outcomes were assessed at 6-month follow-up.
Main Results:
- Forty-two patients were included; 14 with ICP monitoring (CM) and 28 without (SM).
- The CM group presented with lower Glasgow Coma Scale scores and poorer prognosis, yet experienced a lower survival rate.
- No complications were associated with ICP catheter use, and survivors in the CM group had moderate to good outcomes.
Conclusions:
- ICP monitoring in severe TBI patients was associated with higher initial severity and increased mortality.
- Despite higher mortality, survivors who underwent ICP monitoring achieved moderate to good outcomes.
- Further randomized clinical trials are essential to definitively ascertain the impact of ICP monitoring on survival and quality of life in severe TBI.
Introduction:
Severe traumatic brain injury (TBI) is a serious condition. Intracranial pressure (ICP) monitoring can be used to direct treatment, which is of limited access in developing countries.
Objective:
To describe the clinical experience of pediatric patients with severe TBI.
Patients And Method:
A clinical experience in patients with severe TBI was conducted. Age was 1-17 years, exclusion criteria were chronic illness and psicomotor retardation. Informed consent was obtained in each case. Two groups were formed based on the criterion of neurosurgeons: with and without intracraneal pressure (ICP) monitoring. PIC monitoring was performed through a 3PN Spiegelberg catheter and a Spiegelberg HDM 26 monitor. Patients were treated according international pediatric guides. The characteristics of both groups are described at 6 months of follow-up.
Results:
Forty-two patients (CM=14 and SM=28). Those in the CM Group had lower Glasgow coma scale score and Marshall classification with poorer prognosis. Among them survival rate was lower, although the outcome was from moderate to good. No complications were reported with the use of the ICP catheter.
Conclusion:
Patients with ICP monitoring had greater severity at admission and an increased mortality; however, the outcome for the survivors was from moderate to good. It is necessary to conduct randomized clinical trials to define the impact of ICP monitoring on survival and quality of life in severe TBI patients.
Related Concept Videos
01:28Traumatic Brain Injury l: Introduction
01:14Increased Intracranial Pressure l: Introduction
01:29Increased Intracranial Pressure ll: Pathophysiology