Mitsuru Honda1, Ryo Ichibayashi2, Ginga Suzuki2, Hiroki Yokomuro2, Yoshikatsu Seiki3, Shigeru Sase3, Taichi Kishi4. 1. Department of Critical Care Center, Toho University Medical Center Omori Hospital, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan. mhonda@toho-u.ac.jp. 2. Department of Critical Care Center, Toho University Medical Center Omori Hospital, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan. 3. Department of Neurosurgery, Toho University Medical Center Omori Hospital, Tokyo, Japan. 4. Department of Education Planning and Development, Faculty of Medicine, School of Medicine, Toho University, Tokyo, Japan.
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.
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.
Authors: N Stocchetti; K I Penny; M Dearden; R Braakman; F Cohadon; F Iannotti; F Lapierre; A Karimi; A Maas; G D Murray; J Ohman; L Persson; F Servadei; G M Teasdale; T Trojanowski; A Unterberg Journal: Intensive Care Med Date: 2001-02 Impact factor: 17.440
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