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Acta Neurochirurgica
Published in: Acta Neurochirurgica 7/2018

Open Access 01-07-2018 | Original Article - Neurosurgical intensive care

Critical thresholds for intracranial pressure vary over time in non-craniectomised traumatic brain injury patients

Authors: Basil Nourallah, Frederick A. Zeiler, Leanne Calviello, Peter Smielewski, Marek Czosnyka, David K. Menon

Published in: Acta Neurochirurgica | Issue 7/2018

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Abstract

Background

Intracranial pressure (ICP)- and cerebral perfusion pressure (CPP)-guided therapy is central to neurocritical care for traumatic brain injury (TBI) patients. We sought to identify time-dependent critical thresholds for mortality and unfavourable outcome for ICP and CPP in non-craniectomised TBI patients.

Methods

This is a retrospective cohort study of 355 patients with moderate-to-severe TBI who received ICP monitoring and were managed without decompressive craniectomy in a tertiary hospital neurocritical care unit. Patients were grouped in 2 × 2 tables according to survival/death or favourable/unfavourable outcomes at 6 months and serial thresholds of mean ICP and CPP, using increments of 0.1 and 0.5 mmHg respectively. Sequential chi-square analysis was performed, and the thresholds yielding the highest chi-square test statistic were taken as having the best discriminative value for outcome. This process was repeated over monitoring periods of 1, 3, 5 and 7 days and for each day of recording to establish time-dependent thresholds. The same analysis was performed for age and sex subgroups.

Results

Global ICP thresholds were 21.3 and 20.5 mmHg for mortality and unfavourable outcome respectively (p < 0.001). After the first day of ICP monitoring, ICP thresholds fell to between 15 and 20 mmHg and remained significant (p < 0.05). Significant time-dependent CPP thresholds for mortality or unfavourable outcome were often not identified, and no identifiable trends were produced.

Conclusion

Critical ICP thresholds in non-craniectomised TBI patients vary with time and fall below established ICP targets after the first day of monitoring.
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Metadata
Title
Critical thresholds for intracranial pressure vary over time in non-craniectomised traumatic brain injury patients
Authors
Basil Nourallah
Frederick A. Zeiler
Leanne Calviello
Peter Smielewski
Marek Czosnyka
David K. Menon
Publication date
01-07-2018
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 7/2018
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-018-3555-3

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