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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2018; 37(04): 291-296
DOI: 10.1055/s-0038-1675365
Original Article | Artigo Original
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Prognostic Impact of Intracranial Pressure Monitoring in Patients with Severe Traumatic Brain Injury

Impacto prognóstico da monitorização da pressão intracraniana em pacientes com traumatismo cranioencefálico grave
Bárbara Calistro Borchardt
1   Department of Medicine, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
,
Luanna Corrêa de Oliveira Freitas
2   Department of Medicine, Academic Unit of Health Sciences, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
,
Ademar Milton de Souza Filho
2   Department of Medicine, Academic Unit of Health Sciences, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
,
Áurea Maria Soares da Rosa
2   Department of Medicine, Academic Unit of Health Sciences, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
,
Milena Bancer Gabe
2   Department of Medicine, Academic Unit of Health Sciences, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
,
Kristian Madeira
3   Department of Health Sciences with Emphasis on Biostatistics and Epidemiology, Translational Biomedicine Laboratory, Research Group on Applied Quantitative Methods, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
,
Carlos Fernando dos Santos Moreira
1   Department of Medicine, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
› Author Affiliations
Further Information

Publication History

14 May 2018

31 August 2018

Publication Date:
06 November 2018 (online)

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Abstract

Objectives The aim of the present study was to analyze the prognostic impact of intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI).

Methods An observational, retrospective and quantitative study was performed. The sample consisted of 246 patients diagnosed with severe TBI, from January 2009 to August 2017.

Results Out of the total sample, 43.56% of the patients were submitted to ICP monitoring. The mean time of use of the catheter was 1.7 days. In both groups, males were the most affected, and the majority of the patients were < 50 years old. Automobile accident was the main etiology of TBI. In the initial clinical evaluation, mydriatic pupils were related to death and normal pupil reaction at hospital discharge. The monitored group performed a larger number of computed tomography (CT) scans, with a mean of 2.6 examinations, with cerebral edema being the most common finding. Regarding the prognosis, those who used a catheter for ICP monitoring had a 47% reduction in the chance of death when compared with those who did not use the catheter. The stay duration both in the hospital and in the intensive care units was higher in patients who underwent ICP monitoring; periods > 30 days were related to meningitis, especially in those who used the catheter.

Conclusion Patients who used a catheter for ICP monitoring had a significant improvement in survival.

Resumo

Objetivos O objetivo do presente estudo foi verificar o impacto prognóstico da monitorização da pressão intracraniana (PIC) em pacientes com traumatismo cranioencefálico (TCE) grave.

Métodos Foi realizado um estudo observacional, retrospectivo e de natureza quantitativa. A amostra foi composta por 246 pacientes com diagnóstico de TCE grave no período de janeiro de 2009 a agosto de 2017.

Resultados Da amostra total, 43,56% dos pacientes foram submetidos à monitorização da PIC. O tempo médio de uso do cateter foi de 1,7 dias. Em ambos os grupos, o gênero masculino foi o mais acometido, e a idade da maior parte dos pacientes era < 50 anos. Acidente automobilístico foi a principal etiologia do TCE. Na avaliação clínica inicial, pupilas midriáticas relacionaram-se ao óbito, e pupilas isofotorreagentes à alta hospitalar. O grupo monitorizado foi submetido a uma quantidade maior de exames de tomografia computadorizada (TC) do crânio, com uma média de 2,6 exames, sendo edema cerebral o achado mais comum. Quanto ao prognóstico, os pacientes que utilizaram cateter para monitorização da PIC tiveram uma redução de chance de ir a óbito de 47% quando comparados aos que não utilizaram o cateter. O tempo de permanência hospitalar e na unidade de terapia intensiva foi maior para aqueles que receberam monitorização da PIC, sendo que períodos > 30 dias se relacionaram com meningite, principalmente naqueles que utilizaram o cateter.

Conclusão Pacientes que utilizaram cateter para monitorização da PIC tiveram melhora significativa da sobrevida.

Keywords

traumatic brain injury - intracranial pressure - prognosis

Palavras-chave

traumatismo cranioencefálico - pressão intracraniana - prognóstico
 

  • References

  • 1 Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol 2008; 7 (08) 728-741
    CrossrefPubMedGoogle Scholar
  • 2 Alali AS, Fowler RA, Mainprize TG. , et al. Intracranial pressure monitoring in severe traumatic brain injury: results from the American College of Surgeons Trauma Quality Improvement Program. J Neurotrauma 2013; 30 (20) 1737-1746
    CrossrefPubMedGoogle Scholar
  • 3 Magalhães ALG, Souza LC, Faleiro RM, Teixeira AL, Miranda AS. Epidemiologia do traumatismo cranioencefálico no Brasil. Rev Bras Neurol 2017; 53 (02) 15-22
    CrossrefPubMedGoogle Scholar
  • 4 Carlotti CG, Colli BO, Dias LAA. Hipertensão intracraniana. Med Ribeirão Preto 1998; 31 (04) 552-562
    PubMedGoogle Scholar
  • 5 Bratton SL, Chestnut RM, Ghajar J. , et al; Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds. J Neurotrauma 2007; 24 (Suppl. 01) S55-S58
    CrossrefPubMedGoogle Scholar
  • 6 Andrade AF, Paiva WS, Amorim RLO, Figueiredo EG, Rusafa Neto E, Teixeira MJ. Mecanismos de lesão cerebral no traumatismo cranioencefálico. Rev Assoc Med Bras (1992) 2009; 55 (01) 75-81
    CrossrefPubMedGoogle Scholar
  • 7 Ministério da Saúde. Tecnologia para Monitorização da Pressão Intracraniana em pacientes com Traumatismo Cranioencefálico Grave. Relatório de Recomendação da Comissão Nacional de Incorporação de Tecnologias no SUS – CONITEC – 125 2014
    PubMedGoogle Scholar
  • 8 Carney N, Totten AM, O'Reilly C. , et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery 2017; 80 (01) 6-15
    CrossrefPubMedGoogle Scholar
  • 9 Maas AIR, Dearden M, Teasdale GM. , et al; European Brain Injury Consortium. EBIC-guidelines for management of severe head injury in adults. Acta Neurochir (Wien) 1997; 139 (04) 286-294
    CrossrefPubMedGoogle Scholar
  • 10 Andrade AF, Ciquini Jr O, Figueiredo EG, Brock RS, Marino Jr R. Diretrizes do atendimento ao paciente com traumatismo crânioencefálico. Arq Bras Neurocir 1999; 18 (03) 131-176
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Amorin RLO, Andrade AF, Paiva WS. , et al. Management of Diffuse Lesions in Traumatic Brain Injury in Brazil. Austin Neurosurg 2014; 1 (03) 1-4
    PubMedGoogle Scholar
  • 12 Talving P, Karamanos E, Teixeira PG. , et al. Intracranial pressure monitoring in severe head injury: compliance with Brain Trauma Foundation guidelines and effect on outcomes: a prospective study. J Neurosurg 2013; 119 (05) 1248-1254
    CrossrefPubMedGoogle Scholar
  • 13 Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev 2006; (01) CD003983
    PubMedGoogle Scholar
  • 14 Park E, Bell JD, Baker AJ. Traumatic brain injury: can the consequences be stopped?. CMAJ 2008; 178 (09) 1163-1170
    CrossrefPubMedGoogle Scholar
  • 15 Fonseca NM, Jesus PMR, Gomes PCMA. , et al. O valor da monitorização da pressão intracraniana na abordagem terapêutica do traumatismo craniano grave: relato de caso. Rev Med Minas Gerais 2011; 21 (Suppl. 04) 1-113
    PubMedGoogle Scholar
  • 16 Giugno KM, Maia TR, Kunrath CL, Bizzi JJ. [Treatment of intracranial hypertension]. J Pediatr (Rio J) 2003; 79 (04) 287-296
    PubMedGoogle Scholar
  • 17 Farahvar A, Gerber LM, Chiu YL, Carney N, Härtl R, Ghajar J. Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring. J Neurosurg 2012; 117 (04) 729-734
    CrossrefPubMedGoogle Scholar
  • 18 Howells T, Elf K, Jones PA. , et al. Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma. J Neurosurg 2005; 102 (02) 311-317
    CrossrefPubMedGoogle Scholar
  • 19 Shafi S, Diaz-Arrastia R, Madden C, Gentilello L. Intracranial pressure monitoring in brain-injured patients is associated with worsening of survival. J Trauma 2008; 64 (02) 335-340
    CrossrefPubMedGoogle Scholar
  • 20 Haddad S, Aldawood AS, Alferayan A, Russell NA, Tamim HM, Arabi YM. Relationship between intracranial pressure monitoring and outcomes in severe traumatic brain injury patients. Anaesth Intensive Care 2011; 39 (06) 1043-1050
    CrossrefPubMedGoogle Scholar
  • 21 Chesnut RM, Temkin N, Carney N. , et al; Global Neurotrauma Research Group. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 2012; 367 (26) 2471-2481
    CrossrefPubMedGoogle Scholar
  • 22 Mauritz W, Steltzer H, Bauer P, Dolanski-Aghamanoukjan L, Metnitz P. Monitoring of intracranial pressure in patients with severe traumatic brain injury: an Austrian prospective multicenter study. Intensive Care Med 2008; 34 (07) 1208-1215
    CrossrefPubMedGoogle Scholar
  • 23 Ruy EL, Rosa MI. Perfil epidemiológico de pacientes com traumatismo crânio encefálico. Arquivos Catarinenses de Medicina 2011; 40 (03) 17-20
    PubMedGoogle Scholar
  • 24 Gaudêncio TG, Leão GM. A epidemiologia do traumatismo crânio-encefálico: Um levantamento bibliográfico no Brasil. Rev Neurosci 2013; 21 (03) 427-434
    PubMedGoogle Scholar
  • 25 Bruns Jr J, Hauser WA. The epidemiology of traumatic brain injury: a review. Epilepsia 2003; 44 (s10, Suppl 10) 2-10
    PubMedGoogle Scholar
  • 26 Jennett B. Epidemiology of head injury. J Neurol Neurosurg Psychiatry 1996; 60 (04) 362-369
    CrossrefPubMedGoogle Scholar
  • 27 Morgado FL, Rossi LA. Correlação entre a escala de coma de Glasgow e os achados de imagem de tomografia computadorizada em pacientes vítimas de traumatismo cranioencefálico. Radiol Bras 2011; 44 (01) 35-41
    CrossrefPubMedGoogle Scholar
  • 28 Marmarou A, Lu J, Butcher I. , et al. Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma 2007; 24 (02) 270-280
    CrossrefPubMedGoogle Scholar
  • 29 Dosseh G, Gil C. Petrgnani. Traumatisme crânien et mydriase aréactive à la prise em charge initiale: valeur etiologique et pronostic de la mydriase. Lettres à la rédaction. Ann Fr Anesth Reanim 2006; 26: 174-182
    PubMedGoogle Scholar
  • 30 Helmy A, Kirkpatrick PJ, Seeley HM, Corteen E, Menon DK, Hutchinson PJ. Fixed, dilated pupils following traumatic brain injury: historical perspectives, causes and ophthalmological sequelae. Acta Neurochir Suppl (Wien) 2012; 114: 295-299
    PubMedGoogle Scholar
  • 31 Chaudhuri K, Malham GM, Rosenfeld JV. Survival of trauma patients with coma and bilateral fixed dilated pupils. Injury 2009; 40 (01) 28-32
    CrossrefPubMedGoogle Scholar
  • 32 Biersteker HA, Andriessen TM, Trompa J. , et al. Factors influencing intracranial pressure monitoring guideline compliance and outcome after severe traumatic brain injury. Crit Care Med. 2012; 40 (06) 1914-22
    CrossrefPubMedGoogle Scholar
  • 33 Yuan Q, Wu X, Sun Y. , et al. Impact of intracranial pressure monitoring on mortality in patients with traumatic brain injury: a systematic review and meta-analysis. J Neurosurg 2015; 122 (03) 574-587
    CrossrefPubMedGoogle Scholar
  • 34 Mayhall CG, Archer NH, Lamb VA. , et al. Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med 1984; 310 (09) 553-559
    CrossrefPubMedGoogle Scholar
  • 35 Kourbeti IS, Vakis AF, Papadakis JA. , et al. Infections in traumatic brain injury patients. Clin Microbiol Infect 2012; 18 (04) 359-364
    CrossrefPubMedGoogle Scholar
  • 36 Miller MT, Pasquale M, Kurek S. , et al. Initial head computed tomographic scan characteristics have a linear relationship with initial intracranial pressure after trauma. J Trauma 2004; 56 (05) 967-972 , discussion 972–973
    CrossrefPubMedGoogle Scholar
  • 37 Lee B, Newberg A. Neuroimaging in traumatic brain imaging. NeuroRx 2005; 2 (02) 372-383
    CrossrefPubMedGoogle Scholar