Skip to main content

Advertisement

SpringerLink
Log in

Intracranial pressure monitoring in diffuse brain injury—why the developing world needs it more?

  • Original Article - Brain trauma
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Use of ICP monitoring is considered to be part of “standard of care” in management of severe traumatic brain injury, but it is rarely used in developing countries. The authors present a study which evaluates the efficacy and outcomes of ICP monitoring at a high-volume trauma center in India.

Methods

Data on management and outcomes for 126 patients who were admitted with diffuse traumatic brain injury (GCS 3–8) were studied prospectively over an 18-month period. These patients were treated by one of the two specific protocols: ICP monitoring-based or non-ICP monitoring-based. The primary outcome was measured based on 2 weeks mortality and GOS-E at 1, 3, and 6 months. Secondary outcome was measured based on need for brain-specific treatment, length of ICU stay, and radiation exposure.

Results

Mortality in a subset of patients who underwent surgical intervention later due to increased ICP values, drop in GCS, or radiological deterioration was noted to be significantly lower in the ICP monitoring group (p = 0.03), in spite of statistically insignificant difference in overall mortality rates between groups. GOS-E scores at 1 month were significantly better (p = 0.033) in ICP monitoring group, even though they equalized at 3 and 6 months. The need for brain-specific treatment (p < 0.001), radiation exposure (p < 0.001), and length of ICU stay (p = 0.013) was significantly lower in the ICP monitoring group.

Conclusions

ICP monitoring-based treatment protocol helps in achieving faster recovery; lowers mortality rates in operated patients; and reduces ICU stay, radiation exposure, and the need for brain-specific treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ICP:

Intracranial Pressure Monitoring

ICU:

Intensive Care Unit

GCS:

Glasgow Coma Scale

GOS-E:

Glasgow Outcome Scale—Extended

CT:

Computed Tomography

References

  1. Aiolfi A, Khor D, Cho J, Benjamin E, Inaba K, Demetriades D (2018) Intracranial pressure monitoring in severe blunt head trauma: does the type of monitoring device matter? J Neurosurg 128(3):828–833

    Article  PubMed  Google Scholar 

  2. Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R et al (2007) Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma 24(Suppl 1):S37–S44

    PubMed  Google Scholar 

  3. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ et al (2017) Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery 80(1):6–15. https://doi.org/10.1227/NEU.0000000000001432

    PubMed  Google Scholar 

  4. Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W et al (2012) A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 367:2471–2481

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Dhandapani SS, Gupta A, Vivekanandhan S, Sharma BS, Mahapatra AK (2008) Randomized controlled trial of magnesium sulphate in severe closed traumatic brain injury. Indian J Neurotrauma 5:27–33

    Article  Google Scholar 

  6. Farahvar A, Gerber LM, Chiu YL, Carney N, Hartl R, Ghajar J (2012) Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring. J Neurosurg 117:729–734

    Article  PubMed  Google Scholar 

  7. Ferreira CB, Bassi E, Lucena L, Carreta H, Miranda LC, Tierno PF et al (2015) Measurement of intracranial pressure and short-term outcomes of patients with traumatic brain injury: a propensity-matched analysis. Rev Bras Ter Intensiva 27(4):315–321

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gao L, Wu X, Hu J, Jin Y, Han X, Wu X et al (2013) Intensive management and prognosis of 127 cases with traumatic bilateral frontal contusions. World Neurosurg 80:879–888

    Article  PubMed  Google Scholar 

  9. Gerber LM, Chiu YL, Carney N, Hartl R, Ghajar J (2013) Marked reduction in mortality in patients with severe traumatic brain injury. J Neurosurg 119:1583–1590

    Article  PubMed  Google Scholar 

  10. Gupta DK, Bisht A, Batra P, Mathur P, Mahapatra AK (2016) A cost effectiveness based safety and efficacy study of resterilized intra-parenchymal catheter based intracranial pressure monitoring in developing world. Asian J Neurosurg 11(4):416–420. https://doi.org/10.4103/1793-5482.165785

    Article  PubMed  PubMed Central  Google Scholar 

  11. Joseph M (2005) Intracranial pressure monitoring: vital information ignored. Ind J Crit Care Med 9:35–41. https://doi.org/10.4103/0972-5229.16268

    Article  CAS  Google Scholar 

  12. Lundberg N (1960) Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl 36(149):1–193

    CAS  PubMed  Google Scholar 

  13. Marshall LF, Bowers-Marshall S, Klauber MR, Van Berkum Clark M, Eisenberg H, Jane JA et al (1991) A new classification of head injury based on computerized tomography. J Neurosurg 75(Suppl):S14–S20

    Google Scholar 

  14. Su S-H, Wang F, Hai J, Liu N-T, Yu F, Wu Y-F et al (2014) The effects of intracranial pressure monitoring in patients with traumatic brain injury. PLoS One 9:e87432

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sahuquillo J, Biestro A (2014) Is intracranial pressure monitoring still required in the management of severe traumatic brain injury? Ethical and methodological considerations on conducting clinical research in poor and low-income countries. Surg Neurol Int 5:86

    Article  PubMed  PubMed Central  Google Scholar 

  16. Talving P, Karamanos E, Teixeira PG, Skiada D, Lam L, Belzberg H et al (2013) Intracranial pressure monitoring in severe head injury: compliance with Brain Trauma Foundation guidelines and effect on outcomes: a prospective study. J Neurosurg 119:1248–1254

    Article  PubMed  Google Scholar 

  17. Wilson JT, Pettigrew LE, Teasdale GM (1998) Structured interviews for the Glasgow outcome scale and the extended Glasgow outcome scale: guidelines for their use. J Neurotrauma 15:573–585

    Article  CAS  PubMed  Google Scholar 

  18. Yuan Q, Wu X, Sun Y, Yu J, Li Z, Du Z et al (2015) Impact of intracranial pressure monitoring on mortality in patients with traumatic brain injury: a systematic review and meta-analysis. J Neurosurg 122(3):574–587

    Article  PubMed  Google Scholar 

  19. Zeng J, Tong W, Zheng P (2013) Decreased risk of acute kidney injury with intracranial pressure monitoring in patients with moderate or severe brain injury. J Neurosurg 119:1228–1232

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Medical Trust Hospital, M.G. Road, Kochi, Kerala, 682020, India

    Tarang K. Vora, Sudish Karunakaran, Ajay Kumar, Anil Chiluka, Harish Srinivasan, Kanishk Parmar, Srivatsan Thirumalai Vasu, Rahul Srinivasan, H. A. Chandan, P. S. Vishnu & Lakshay Raheja

Authors
  1. Tarang K. Vora
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sudish Karunakaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ajay Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anil Chiluka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Harish Srinivasan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kanishk Parmar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Srivatsan Thirumalai Vasu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rahul Srinivasan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. H. A. Chandan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. P. S. Vishnu
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Lakshay Raheja
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sudish Karunakaran.

Ethics declarations

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.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee (Medical Trust Hospital, Ethics & Scientific Committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. Identifying information regarding participants is not included in the study.

Additional information

Comments

The present study evaluates ICP monitoring in diffuse traumatic brain injury in a developing country (India) by comparing one group of patients with ICP monitoring (n = 67) and one group without (n = 59). The patients were allocated to the different management according to the protocol applied by the senior attending consultant neurosurgeon. It was reported that the ICP monitoring group improved faster, received less brain-specific treatment, and had fewer CT scans, less nephrological problems, shorter length of stay in the ICU, and better 1 month clinical outcome.

This is a valuable attempt to evaluate ICP monitoring in a developing country where ICP monitoring is not mandatory. It is also interesting to get an impression of how patients are managed without ICP monitoring, which is very different compared to escalated ICP-guided management protocols.

Per Enblad

Uppsala, Sweden

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vora, T.K., Karunakaran, S., Kumar, A. et al. Intracranial pressure monitoring in diffuse brain injury—why the developing world needs it more?. Acta Neurochir 160, 1291–1299 (2018). https://doi.org/10.1007/s00701-018-3538-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-018-3538-4

Keywords

Search

Navigation