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Intracranial pressure monitoring after primary decompressive craniectomy in traumatic brain injury: a clinical study

  • Original Article - Brain Injury
  • Published:
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Abstract

Background

Intracranial pressure (ICP) monitoring represents an important tool in the management of traumatic brain injury (TBI). Although current information exists regarding ICP monitoring in secondary decompressive craniectomy (DC), little is known after primary DC following emergency hematoma evacuation.

Methods

Retrospective analysis of prospectively collected data. Inclusion criteria were age ≥18 years and admission to the intensive care unit (ICU) for TBI and ICP monitoring after primary DC. Exclusion criteria were ICU length of stay (LOS) <1 day and pregnancy. Major objectives were: (1) to analyze changes in ICP/cerebral perfusion pressure (CPP) after primary DC, (2) to evaluate the relationship between ICP/CPP and neurological outcome and (3) to characterize and evaluate ICP-driven therapies after DC.

Results

A total of 34 patients were enrolled. Over 308 days of ICP/CPP monitoring, 130 days with at least one episode of intracranial hypertension (26 patients, 76.5%) and 57 days with at least one episode of CPP <60 mmHg (22 patients, 64.7%) were recorded. A statistically significant relationship was discovered between the Glasgow Outcome Scale (GOS) scores and mean post-decompression ICP (p < 0.04) and between GOS and CPP minimum (CPPmin) (p < 0.04). After DC, persisting intracranial hypertension was treated with: barbiturate coma (n = 7, 20.6%), external ventricular drain (EVD) (n = 4, 11.8%), DC diameter widening (n = 1, 2.9%) and removal of newly formed hematomas (n = 3, 8.8%).

Conclusion

Intracranial hypertension and/or low CPP occurs frequently after primary DC; their occurence is associated with an unfavorable neurological outcome. ICP monitoring appears useful in guiding therapy after primary DC.

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Acknowledgements

We would like to thank Mario Mergoni, MD, and Tracy K. McIntosh, PhD, for their valuable suggestions.

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Authors and Affiliations

  1. I Servizio Anestesia Rianimazione, Azienda Ospedaliero Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy

    Edoardo Picetti & Maria Luisa Caspani

  2. Neurochirugia e Neurotraumatologia, Azienda Ospedaliero Universitaria di Parma and Arcispedale Santa Maria Nuova di Reggio Emilia, Parma and Reggio Emilia, Italy

    Corrado Iaccarino, Giulia Pastorello, Edoardo Viaroli & Franco Servadei

  3. Servizio di Anestesia e Rianimazione, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy

    Pierpaolo Salsi

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  1. Edoardo Picetti
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  2. Maria Luisa Caspani
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  3. Corrado Iaccarino
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Correspondence to Edoardo Picetti.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Picetti, E., Caspani, M.L., Iaccarino, C. et al. Intracranial pressure monitoring after primary decompressive craniectomy in traumatic brain injury: a clinical study. Acta Neurochir 159, 615–622 (2017). https://doi.org/10.1007/s00701-017-3118-z

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  • DOI: https://doi.org/10.1007/s00701-017-3118-z

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