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Intracranial pressure monitoring in diffuse brain injury-why the developing world needs it more?

Tarang K Vora1, Sudish Karunakaran2, Ajay Kumar1

  • 1Department of Neurosurgery, Medical Trust Hospital, M.G. Road, Kochi, Kerala, 682020, India.

Acta Neurochirurgica
|April 27, 2018
PubMed

Insights

Intracranial pressure (ICP) monitoring in severe traumatic brain injury patients significantly reduced mortality in operated cases and improved recovery. This approach also decreased ICU stay, radiation exposure, and the need for brain-specific treatments.

Area of Science:

  • Neurosurgery
  • Trauma Care
  • Critical Care Medicine

Background:

  • Intracranial pressure (ICP) monitoring is standard for severe traumatic brain injury (TBI) but underutilized in developing nations.
  • This study assesses ICP monitoring efficacy at a high-volume Indian trauma center.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of ICP monitoring in severe TBI patients in India.
  • To compare ICP monitoring-based protocols with non-ICP monitoring-based protocols.

Main Methods:

  • Prospective study of 126 severe TBI patients (GCS 3-8) over 18 months.
  • Patients managed with either ICP monitoring-based or non-ICP monitoring-based protocols.
  • Primary outcomes: 2-week mortality and Glasgow Outcome Scale-Extended (GOS-E) at 1, 3, 6 months. Secondary outcomes: brain-specific treatment, ICU stay, radiation exposure.

Main Results:

  • Significantly lower mortality in operated patients with ICP monitoring (p=0.03).
  • Improved 1-month GOS-E scores in the ICP monitoring group (p=0.033), with scores equalizing later.
  • Reduced need for brain-specific treatment (p<0.001), radiation exposure (p<0.001), and ICU stay (p=0.013) with ICP monitoring.

Conclusions:

  • ICP monitoring protocols facilitate faster recovery in severe TBI.
  • ICP monitoring reduces mortality in surgically treated patients and decreases resource utilization.
  • Implementing ICP monitoring can improve outcomes in resource-limited settings.
Abstract

Keywords:
Diffuse traumatic brain injuryIntracranial pressure monitoringNeuro-intensive careSevere head injury

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