ICP management in patients suffering from traumatic brain injury: a systematic review of randomized controlled trials
Severe traumatic brain injury (sTBI) is a major cause of morbidity and mortality. Intracranial pressure (ICP) monitoring and management form the cornerstone of treatment paradigms for sTBI in developed countries. We examine the available randomized controlled trial (RCT) data on the impact of ICP management on clinical outcomes after sTBI.
A systematic review of the literature on ICP management following sTBI was performed to identify pertinent RCT articles.
We identified six RCT articles that examined whether ICP monitoring, decompressive craniectomy, or barbiturate coma improved clinical outcomes after sTBI. These studies support (1) the utility of ICP monitoring in the management of sTBI patients and (2) craniectomy and barbiturate coma as effective methods for the management of intracranial hypertension secondary to sTBI. However, despite adequate ICP control in sTBI patients, a significant proportion of surviving patients remain severely disabled.
If one sets the bar at the level of functional independence, then the RCT data raises questions pertaining to the utility of decompressive craniectomy and barbiturate coma in the setting of sTBI.
KeywordsTraumatic brain injury Intracranial pressure Decompressive craniectomy
Compliance with ethical standards
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Ethics approval/informed consent
This literature review did not involve direct human procedures. This article does not contain any studies with human participants performed by any of the authors. For this type of study formal consent is not required.
- 1.Agrawal A, Coronado VG, Bell JM, Baisakhiya N, Kakani A, Galwankar S, Dwivedi S (2014) Characteristics of patients who died from traumatic brain injury in two rural hospital emergency Departments in Maharashtra, India, 2007-2009. Int J Crit Illn Inj Sci 4:293–297CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Andrews PJD, Sinclair HL, Rodriguez A, Harris BA, Battison CG, Rhodes JKJ, Murray GD, Eurotherm Trial C, Noble D, Galt S, Taylor J, Addison J, Wallis C, Paterson R, Harris G, Mullan B, Quinn V, Bannon L, Gordon A, Templeton M, Wilson R, Thomas E, McMillan H, Tantam K, Gratrix A, Smith N, Martinson V, Barrera-Groba C, Littlejohn I, Spurling G, Hopkins P, Casboult S, Hadfield D, McKinlay J, Beardow Z, Elliot S, Jain R, Bellini A, McCluskey T, Harvey D, Chikhani M, Bolland A, Waldmann C, Jacques N, Prowse H, Turnbull D, Eapen G, Birchall K, Verma V, Creary T, Niebrzegowska E, Owen T, Baldwin J, Williams A, Thompson C, Salt R, Cartlidge D, Vincent A, Calder V, Scott C, Ferris P, Roberts J, Evans T, Burgess N, Della Torre V, Mellinghoff J, Stotz M, Hauer V, Ochelli-Okpue A, McMahon C, Tweedie I, Murray L, Bassford C, Ward G, McCauley M, Wise M, Palmer N, Cole J, Damas F, Xavier N, Duliere G-L, Simoens G, Biston P, Joosten A, Simon M, Antoine A, Zieppen B, Bulpa P, Dive A, Bouhon S, Taccone F, Vincent J-L, Durand D, Spapen H, Troubleyn J, Van Malderen C, Toome V, Sillaots P, Koger I, Stuttmann R, Jakubetz J, Langer S, Michalia M, Clouva-Molyvdas P-M, Vassiliadis I, Nanas S, Douka L, Dimopolous S, Pneumatikos I, Dragoumanis C, Kouliatsis G, Nakos G, Kostanti E, Zakynthinos E, Makris D, Palli E, Koukoulitsios G, Tsikritsaki K, Kalogeromitros A, Nagy E, Lampiri C, Valtoy M, Barzo P, Kis D, Fulop B, Gupta D, Bindra A, Breen D, Barry J, Neau E, Spoto M, Fusilli N, Malossini S, Antonelli M, Caricato A, Tersali A, Seabra F, Aragao I, Antunes R, Petrikov S, Titova J, Solodov A, Al-Jabbary A, Deeb A, Richi H, del Campo MM, Casado JMT, Perez EB, Perez AZ, Diez MA, Echeverri SO, Blesa A, Romero F, Sanchez M, van der Jagt M, Haitsma I, van Duijn D, Dennesen P, Koole M, Krishnareddy K, Hegazi M, Sharma BS (2015) Hypothermia for intracranial hypertension after traumatic brain injury. N Engl J Med 373:2403–2412CrossRefPubMedGoogle Scholar
- 3.Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons (2007) Guidelines for the management of severe traumatic brain injury. J Neurotrauma 24(Suppl 1):S1–106Google Scholar
- 4.Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J (2017) Guidelines for the Management of Severe Traumatic Brain Injury, fourth edition. Neurosurgery 80:6–15PubMedGoogle Scholar
- 6.Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, Petroni G, Lujan S, Pridgeon J, Barber J, Machamer J, Chaddock K, Celix JM, Cherner M, Hendrix T, Global Neurotrauma Research G (2012) A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 367:2471–2481CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D’Urso P, Kossmann T, Ponsford J, Seppelt I, Reilly P, Wolfe R, DECRA Trial Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group (2011) Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 364:1493–1502CrossRefPubMedGoogle Scholar
- 11.El-Matbouly M, El-Menyar A, Al-Thani H, Tuma M, El-Hennawy H, AbdulRahman H, Parchani A, Peralta R, Asim M, El-Faramawy A, Zarour A, Latifi R (2013) Traumatic brain injury in Qatar: age matters—insights from a 4-year observational study. ScientificWorldJournal 2013:354920CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ, Collaborators RT (2016) Trial of Decompressive Craniectomy for traumatic intracranial hypertension. N Engl J Med 375:1119–1130CrossRefPubMedGoogle Scholar
- 16.Lee KK, Seow WT, Ng I (2006) Demographical profiles of adult severe traumatic brain injury patients: implications for healthcare planning. Singap Med J 47:31–36Google Scholar
- 17.Marshall LF, Marshall SB, Klauber MR, Clark MB, Eisenberg HM, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1991) A new classification of head injury based on computerized tomography. J Neurosurg 75(Suppl 1):S14–S20Google Scholar
- 24.Talving P, Karamanos E, Teixeira PG, Skiada D, Lam L, Belzberg H, Inaba K, Demetriades D (2013) Intracranial pressure monitoring in severe head injury: compliance with brain trauma foundation guidelines and effect on outcomes: a prospective study. J Neurosurg 119:1248–1254CrossRefPubMedGoogle Scholar
- 25.Traumatic Brain Injury in the United States (2010) Centers for Disease Control and Prevention. Accessed June 15th, 2016. Available from: http://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf