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Patterns of Increased Intracranial Pressure After Severe Traumatic Brain Injury

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Abstract

Introduction

Secondary brain injury due to increased intracranial pressure (ICP) contributes to post-traumatic morbidity and mortality. Although it is often taught that increased ICP begins early after traumatic brain injury, some patients develop increased ICP after the first 3 days post-injury. We examined our data to describe temporal patterns of increased ICP.

Methods

This is a retrospective review of prospectively collected physiologic and demographic data.

Results

Seventy-seven patients were included. We identified four patterns of increased ICP: beginning within 72 h (early), beginning after 72 h (late), early increases with resolution, and then a second rise after 72 h (bimodal), and continuously increased ICP. Late increases in ICP occur in 17% of this cohort. Peak day of swelling was day 7 for the “late” rise group and day 4 for the other patients with increased ICP. Forty-four percent of patients showed enlargement of cerebral contusions on follow-up imaging at 24 h post-injury.

Conclusions

Late rises in ICP were not rare in this cohort. This is clinically relevant as it may impact decisions about ICP monitor removal. Differences between groups in age, CT patterns of injury, fluid therapy, osmotic use, and fever were not statistically significant.

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Acknowledgments

The findings of this study do not necessarily represent the views of The Queen’s Medical Center. Sources of financial and material support: Queen Emma Research fund RA-2005-055.

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Authors and Affiliations

  1. Neuroscience Institute, Queen’s Medical Center, Honolulu, HI, 96813, USA

    Kristine H. O’Phelan, Dalnam Park, Katherine Johnson, Melanie Albano, Juliet Beniga, Deborah M. Green & Cherylee W. J. Chang

  2. Departments of Medicine and Surgery, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, 96813, USA

    Kristine H. O’Phelan, Deborah M. Green & Cherylee W. J. Chang

  3. Department of Neurology, University of Miami Miller School of Medicine, 1120 NW 14th St., CRB 1358, Miami, FL, 33136, USA

    Kristine H. O’Phelan

  4. Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital, Cincinnati, OH, 45229, USA

    Jimmy T. Efird

Authors
  1. Kristine H. O’Phelan
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  2. Dalnam Park
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  3. Jimmy T. Efird
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  4. Katherine Johnson
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  5. Melanie Albano
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  6. Juliet Beniga
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  7. Deborah M. Green
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  8. Cherylee W. J. Chang
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Corresponding author

Correspondence to Kristine H. O’Phelan.

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O’Phelan, K.H., Park, D., Efird, J.T. et al. Patterns of Increased Intracranial Pressure After Severe Traumatic Brain Injury. Neurocrit Care 10, 280–286 (2009). https://doi.org/10.1007/s12028-008-9183-7

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  • DOI: https://doi.org/10.1007/s12028-008-9183-7

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