Twenty-Five Years of Intracranial Pressure Monitoring After Severe Traumatic Brain Injury: A Retrospective, Single-Center Analysis

Joseph Donnelly*, Marek Czosnyka, Hadie Adams, Danilo Cardim, Angelos G. Kolias, Frederick A. Zeiler, Andrea Lavinio, Marcel Aries, Chiara Robba, Peter Smielewski, Peter J. A. Hutchinson, David K. Menon, John D. Pickard, Karol P. Budohoski

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

47 Citations (Web of Science)

Abstract

BACKGROUND Intracranial pressure (ICP) is a clinically important variable after severe traumatic brain injury (TBI) and has been monitored, along with clinical outcome, for over 25 yr in Addenbrooke's hospital, Cambridge, United Kingdom. This time period has also seen changes in management strategies with the implementation of protocolled specialist neurocritical care, expansion of neuromonitoring techniques, and adjustments of clinical treatment targets.

OBJECTIVE To describe the changes in intracranial monitoring variables over the past 25 yr.

METHODS Data from 1146 TBI patients requiring ICP monitoring were analyzed. Monitored variables included ICP, cerebral perfusion pressure (CPP), and the cerebral pressure reactivity index (PRx). Data were stratified into 5-yr epochs spanning the 25 yr from 1992 to 2017.

RESULTS CPP increased sharply with specialist neurocritical care management (P

CONCLUSION We demonstrate the evolving trends in neurophysiological monitoring over the past 25 yr from a single, academic neurocritical care unit. ICP and CPP were responsive to the introduction of an ICP/CPP protocol while PRx has remained unchanged.

Original languageEnglish
Pages (from-to)E75-E82
Number of pages8
JournalNeurosurgery
Volume85
Issue number1
DOIs
Publication statusPublished - Jul 2019

Keywords

  • Traumatic brain injury
  • Intracranial pressure
  • Cerebral hemodynamics
  • Autoregulation
  • Outcome
  • CEREBRAL PERFUSION-PRESSURE
  • CEREBROVASCULAR REACTIVITY
  • DECOMPRESSIVE CRANIECTOMY
  • HEAD-INJURY
  • MANAGEMENT
  • AUTOREGULATION
  • BEDSIDE
  • CARE
  • THRESHOLDS
  • TRIAL

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