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

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?

SUBMITTER: Nourallah B 

PROVIDER: S-EPMC5996002 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature