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

doi:10.1093/neuros/nyy468

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 journal › Article › Academic › peer-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 language	English
Pages (from-to)	E75-E82
Number of pages	8
Journal	Neurosurgery
Volume	85
Issue number	1
DOIs	https://doi.org/10.1093/neuros/nyy468
Publication status	Published - 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

Access to Document

10.1093/neuros/nyy468

Full text Final published version, 1.33 MBLicence: Taverne

Cite this

Donnelly, J., Czosnyka, M., Adams, H., Cardim, D., Kolias, A. G., Zeiler, F. A., Lavinio, A., Aries, M., Robba, C., Smielewski, P., Hutchinson, P. J. A., Menon, D. K., Pickard, J. D., & Budohoski, K. P. (2019). Twenty-Five Years of Intracranial Pressure Monitoring After Severe Traumatic Brain Injury: A Retrospective, Single-Center Analysis. Neurosurgery, 85(1), E75-E82. https://doi.org/10.1093/neuros/nyy468

Donnelly, Joseph ; Czosnyka, Marek ; Adams, Hadie ; Cardim, Danilo ; Kolias, Angelos G. ; Zeiler, Frederick A. ; Lavinio, Andrea ; Aries, Marcel ; Robba, Chiara ; Smielewski, Peter ; Hutchinson, Peter J. A. ; Menon, David K. ; Pickard, John D. ; Budohoski, Karol P. / Twenty-Five Years of Intracranial Pressure Monitoring After Severe Traumatic Brain Injury : A Retrospective, Single-Center Analysis. In: Neurosurgery. 2019 ; Vol. 85, No. 1. pp. E75-E82.

@article{4ef0f4d201e34aa6a96d82217add86c6,

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

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 (PCONCLUSION 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.",

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",

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

year = "2019",

month = jul,

doi = "10.1093/neuros/nyy468",

language = "English",

volume = "85",

pages = "E75--E82",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Oxford University Press",

number = "1",

}

Donnelly, J, Czosnyka, M, Adams, H, Cardim, D, Kolias, AG, Zeiler, FA, Lavinio, A, Aries, M, Robba, C, Smielewski, P, Hutchinson, PJA, Menon, DK, Pickard, JD & Budohoski, KP 2019, 'Twenty-Five Years of Intracranial Pressure Monitoring After Severe Traumatic Brain Injury: A Retrospective, Single-Center Analysis', Neurosurgery, vol. 85, no. 1, pp. E75-E82. https://doi.org/10.1093/neuros/nyy468

Twenty-Five Years of Intracranial Pressure Monitoring After Severe Traumatic Brain Injury : A Retrospective, Single-Center Analysis. / Donnelly, Joseph; Czosnyka, Marek; Adams, Hadie; Cardim, Danilo; Kolias, Angelos G.; Zeiler, Frederick A.; Lavinio, Andrea; Aries, Marcel; Robba, Chiara; Smielewski, Peter; Hutchinson, Peter J. A.; Menon, David K.; Pickard, John D.; Budohoski, Karol P.

In: Neurosurgery, Vol. 85, No. 1, 07.2019, p. E75-E82.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Twenty-Five Years of Intracranial Pressure Monitoring After Severe Traumatic Brain Injury

T2 - A Retrospective, Single-Center Analysis

AU - Donnelly, Joseph

AU - Czosnyka, Marek

AU - Adams, Hadie

AU - Cardim, Danilo

AU - Kolias, Angelos G.

AU - Zeiler, Frederick A.

AU - Lavinio, Andrea

AU - Aries, Marcel

AU - Robba, Chiara

AU - Smielewski, Peter

AU - Hutchinson, Peter J. A.

AU - Menon, David K.

AU - Pickard, John D.

AU - Budohoski, Karol P.

PY - 2019/7

Y1 - 2019/7

N2 - 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 (PCONCLUSION 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.

AB - 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 (PCONCLUSION 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.

KW - Traumatic brain injury

KW - Intracranial pressure

KW - Cerebral hemodynamics

KW - Autoregulation

KW - Outcome

KW - CEREBRAL PERFUSION-PRESSURE

KW - CEREBROVASCULAR REACTIVITY

KW - DECOMPRESSIVE CRANIECTOMY

KW - HEAD-INJURY

KW - MANAGEMENT

KW - AUTOREGULATION

KW - BEDSIDE

KW - CARE

KW - THRESHOLDS

KW - TRIAL

U2 - 10.1093/neuros/nyy468

DO - 10.1093/neuros/nyy468

M3 - Article

C2 - 30476233

VL - 85

SP - E75-E82

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 1

ER -