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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2023; 42(04): e277-e281
DOI: 10.1055/s-0041-1731012
Original Article

Intracranial Pressure Monitoring in Patients with Severe Traumatic Brain Injury: A Cohort Study with Paired Analysis

Monitorização da pressão intracraniana em pacientes vítimas de traumatismo craniencefálico grave: Um estudo coorte com análise pareada
Gabriel Saboia de Araújo Torres 
1   Divisão de Neurologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP. Brazil
,
Wellingson Silva Paiva 
2   Divisão de Neurocirurgia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Robson Luís Oliveira de Amorim 
2   Divisão de Neurocirurgia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
3   Universidade Federal do Amazonas, Manaus, AM, Brazil
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Abstract

Introduction Intracranial hypertension continues to be the most frequent cause of death in patients with traumatic brain injury (TBI). Thus, invasive monitoring of intracranial pressure (ICP) is a very important tool in neurointensivism. However, there is controversy regarding ICP monitoring and prognosis.

Objectives To evaluate whether there is a difference in mortality between patients with severe TBI who underwent invasive ICP monitoring compared with those who did not undergo such procedure.

Methodology This is a unicentric study in the prospective cohort mode. A total of 316 patients with severe TBI were evaluated and, out of these 316 individuals, 35 were submitted to ICP monitoring. All clinical data were evaluated by the Tertiary Hospital Neurosurgery team in the city of São Paulo.

Results Of the total cohort, 35 (11%) patients underwent ICP monitoring, while 281 did not. Comparing the 2 groups, there was no difference in terms of early mortality between patients who were submitted to monitoring and those who were not (34.3 versus 14.3%; p = 0.09); there was also no difference in terms of hospital mortality (40 versus 28.5%; p = 0.31) or intensive care unit (ICU) length of stay (16.10 days, 95% confidence interval [CI]: 10.6–21.6; versus 20.60 days, 95%CI: 13.50–27.70; p = 0.31).

Conclusions In this cohort, we did not identify differences in mortality or in duration of hospitalization between patients with ICP monitoring and those exclusively with clinical-radiological evaluation. However, further national co-operative studies of services using ICP monitoring are needed to achieve results with greater generalization power.

Resumo

Introdução A hipertensão intracraniana continua a ser a causa mais frequente de morte em pacientes com traumatismo craniencefálico (TCE). Assim, a monitoração invasiva da pressão intracraniana (PIC) é uma ferramenta de grande importância em neurointensivismo. No entanto, há controvérsias em relação à monitorização da PIC e sua relação com o prognóstico.

Objetivos Avaliar se há diferença de mortalidade entre pacientes com TCE grave submetidos à monitorização invasiva da PIC em comparação com aqueles não monitorizados.

Metodologia Trata-se de um estudo unicêntrico no modo de coorte prospectiva. Foram avaliados 316 pacientes com TCE grave e, desses 316 indivíduos, 35 foram submetidos à monitorização da PIC. Todos os dados clínicos foram avaliados pela equipe de Neurocirurgia de Hospital Terciário na cidade de São Paulo.

Resultados Da coorte total, 35 (11%) pacientes foram submetidos a monitorização da PIC, enquanto 281 não o foram. Comparando-se os 2 grupos, não houve diferença em termos de mortalidade precoce entre pacientes submetidos a monitorização e os que não foram submetidos (34,3 versus 14,3%; p = 0,09); não houve também diferença em termos de mortalidade hospitalar (40 versus 28,5%; p = 0,31) ou no tempo de internação na UTI (16,10 dias, intervalo de confiança [IC] 95%: 10,6–21,6 versus 20,60 dias, IC95%: 13,50–27,70; p = 0,31).

Conclusões Nesta coorte, não identificamos diferença de mortalidade ou de duração de tempo de internação entre pacientes com monitorização da PIC e aqueles com avaliação exclusivamente clínicorradiológica. Fazem-se, no entanto, necessários mais estudos cooperativos nacionais dos serviços que utilizam a monitorização da PIC para obtenção de resultados com maior poder de generalização.

Keywords

intracranial pressure - hospital mortality - intracranial hypertension - brain injuries - traumatic

Palavras-chave

pressão intracraniana - mortalidade hospitalar - hipertensão intracraniana - lesões encefálicas - traumáticas

Note

The present study was performed at the Hospital das Clínicas of the Medical School of the Universidade de São Paulo.




Publication History

Received: 02 November 2020

Accepted: 09 March 2021

Article published online:
18 October 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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