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Neurocritical Care
Published in: Neurocritical Care 3/2017

01-12-2017 | Original Article

Consideration of the Intracranial Pressure Threshold Value for the Initiation of Traumatic Brain Injury Treatment: A Xenon CT and Perfusion CT Study

Authors: Mitsuru Honda, Ryo Ichibayashi, Ginga Suzuki, Hiroki Yokomuro, Yoshikatsu Seiki, Shigeru Sase, Taichi Kishi

Published in: Neurocritical Care | Issue 3/2017

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Abstract

Background

Monitoring of intracranial pressure (ICP) is considered to be fundamental for the care of patients with severe traumatic brain injury (TBI) and is routinely used to direct medical and surgical therapy. Accordingly, some guidelines for the management of severe TBI recommend that treatment be initiated for ICP values >20 mmHg. However, it remained to be accounted whether there is a scientific basis to this instruction. The purpose of the present study was to clarify whether the basis of ICP values >20 mmHg is appropriate.

Subject and Methods

We retrospectively reviewed 25 patients with severe TBI who underwent neuroimaging during ICP monitoring within the first 7 days. We measured cerebral blood flow (CBF), mean transit time (MTT), cerebral blood volume (CBV), and ICP 71 times within the first 7 days.

Results

Although the CBF, MTT, and CBV values were not correlated with the ICP value at ICP values ≤20 mmHg, the CBF value was significantly negatively correlated with the ICP value (r = −0.381, P < 0.05) at ICP values >20 mmHg. The MTT value was also significantly positively correlated with the ICP value (r = 0.638, P < 0.05) at ICP values >20 mmHg.

Conclusion

The cerebral circulation disturbance increased with the ICP value. We demonstrated the cerebral circulation disturbance at ICP values >20 mmHg. This study suggests that an ICP >20 mmHg is the threshold to initiate treatments. An active treatment intervention would be required for severe TBI when the ICP was >20 mmHg.
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Metadata
Title
Consideration of the Intracranial Pressure Threshold Value for the Initiation of Traumatic Brain Injury Treatment: A Xenon CT and Perfusion CT Study
Authors
Mitsuru Honda
Ryo Ichibayashi
Ginga Suzuki
Hiroki Yokomuro
Yoshikatsu Seiki
Shigeru Sase
Taichi Kishi
Publication date
01-12-2017
Publisher
Springer US
Published in
Neurocritical Care / Issue 3/2017
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-017-0432-5

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