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Consideration of the Intracranial Pressure Threshold Value for the Initiation of Traumatic Brain Injury Treatment: A Xenon CT and Perfusion CT Study

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Abstract

Background

Monitoring of intracranial pressure (ICP) is considered to be fundamental for the care of patients with severe traumatic brain injury (TBI) and is routinely used to direct medical and surgical therapy. Accordingly, some guidelines for the management of severe TBI recommend that treatment be initiated for ICP values >20 mmHg. However, it remained to be accounted whether there is a scientific basis to this instruction. The purpose of the present study was to clarify whether the basis of ICP values >20 mmHg is appropriate.

Subject and Methods

We retrospectively reviewed 25 patients with severe TBI who underwent neuroimaging during ICP monitoring within the first 7 days. We measured cerebral blood flow (CBF), mean transit time (MTT), cerebral blood volume (CBV), and ICP 71 times within the first 7 days.

Results

Although the CBF, MTT, and CBV values were not correlated with the ICP value at ICP values ≤20 mmHg, the CBF value was significantly negatively correlated with the ICP value (r = −0.381, P < 0.05) at ICP values >20 mmHg. The MTT value was also significantly positively correlated with the ICP value (r = 0.638, P < 0.05) at ICP values >20 mmHg.

Conclusion

The cerebral circulation disturbance increased with the ICP value. We demonstrated the cerebral circulation disturbance at ICP values >20 mmHg. This study suggests that an ICP >20 mmHg is the threshold to initiate treatments. An active treatment intervention would be required for severe TBI when the ICP was >20 mmHg.

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Authors and Affiliations

  1. Department of Critical Care Center, Toho University Medical Center Omori Hospital, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan

    Mitsuru Honda, Ryo Ichibayashi, Ginga Suzuki & Hiroki Yokomuro

  2. Department of Neurosurgery, Toho University Medical Center Omori Hospital, Tokyo, Japan

    Yoshikatsu Seiki & Shigeru Sase

  3. Department of Education Planning and Development, Faculty of Medicine, School of Medicine, Toho University, Tokyo, Japan

    Taichi Kishi

Authors
  1. Mitsuru Honda
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  2. Ryo Ichibayashi
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  4. Hiroki Yokomuro
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  5. Yoshikatsu Seiki
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  6. Shigeru Sase
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  7. Taichi Kishi
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Correspondence to Mitsuru Honda.

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The authors declare that they have no conflicts of interest.

Ethical Standard

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. The study protocol was approved by the ethics committee of our institute (Ethics Committee Toho University Omori Medical Center).

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Honda, M., Ichibayashi, R., Suzuki, G. et al. Consideration of the Intracranial Pressure Threshold Value for the Initiation of Traumatic Brain Injury Treatment: A Xenon CT and Perfusion CT Study. Neurocrit Care 27, 308–315 (2017). https://doi.org/10.1007/s12028-017-0432-5

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  • DOI: https://doi.org/10.1007/s12028-017-0432-5

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