Joseph Donnelly1,2, Marek Czosnyka1,3, Hadie Adams1, Danilo Cardim1,4, Angelos G Kolias1,5, Frederick A Zeiler6,7,8, Andrea Lavinio6, Marcel Aries1,9, Chiara Robba6,10, Peter Smielewski1, Peter J A Hutchinson1,5,11, David K Menon5,6, John D Pickard1,11, Karol P Budohoski1,5,11. 1. Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom. 2. Department of Anaesthesiology, University of Auckland, Auckland, New Zealand. 3. Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland. 4. Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, Canada. 5. NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom. 6. Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, United Kingdom. 7. Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. 8. Clinician Investigator Program, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. 9. Department of Intensive Care, University of Maastricht, Maastricht University Medical Center, Maastricht, Netherlands. 10. Department of Anaesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology, University of Genoa, Genoa, Italy. 11. Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
Abstract
BACKGROUND: Intracranial pressure (ICP) is a clinically important variable after severe traumatic brain injury (TBI) and has been monitored, along with clinical outcome, for over 25 yr in Addenbrooke's hospital, Cambridge, United Kingdom. This time period has also seen changes in management strategies with the implementation of protocolled specialist neurocritical care, expansion of neuromonitoring techniques, and adjustments of clinical treatment targets. OBJECTIVE: To describe the changes in intracranial monitoring variables over the past 25 yr. METHODS: Data from 1146 TBI patients requiring ICP monitoring were analyzed. Monitored variables included ICP, cerebral perfusion pressure (CPP), and the cerebral pressure reactivity index (PRx). Data were stratified into 5-yr epochs spanning the 25 yr from 1992 to 2017. RESULTS: CPP increased sharply with specialist neurocritical care management (P < 0.0001) (introduction of a specific TBI management algorithm) before stabilizing from 2000 onwards. ICP decreased significantly over the 25 yr of monitoring from an average of 19 to 12 mmHg (P < 0.0001) but PRx remained unchanged. The mean number of ICP plateau waves and the number of patients developing refractory intracranial hypertension both decreased significantly. Mortality did not significantly change in the cohort (22%). CONCLUSION: We demonstrate the evolving trends in neurophysiological monitoring over the past 25 yr from a single, academic neurocritical care unit. ICP and CPP were responsive to the introduction of an ICP/CPP protocol while PRx has remained unchanged.
BACKGROUND: Intracranial pressure (ICP) is a clinically important variable after severe traumatic brain injury (TBI) and has been monitored, along with clinical outcome, for over 25 yr in Addenbrooke's hospital, Cambridge, United Kingdom. This time period has also seen changes in management strategies with the implementation of protocolled specialist neurocritical care, expansion of neuromonitoring techniques, and adjustments of clinical treatment targets. OBJECTIVE: To describe the changes in intracranial monitoring variables over the past 25 yr. METHODS: Data from 1146 TBIpatients requiring ICP monitoring were analyzed. Monitored variables included ICP, cerebral perfusion pressure (CPP), and the cerebral pressure reactivity index (PRx). Data were stratified into 5-yr epochs spanning the 25 yr from 1992 to 2017. RESULTS: CPP increased sharply with specialist neurocritical care management (P < 0.0001) (introduction of a specific TBI management algorithm) before stabilizing from 2000 onwards. ICP decreased significantly over the 25 yr of monitoring from an average of 19 to 12 mmHg (P < 0.0001) but PRx remained unchanged. The mean number of ICP plateau waves and the number of patients developing refractory intracranial hypertension both decreased significantly. Mortality did not significantly change in the cohort (22%). CONCLUSION: We demonstrate the evolving trends in neurophysiological monitoring over the past 25 yr from a single, academic neurocritical care unit. ICP and CPP were responsive to the introduction of an ICP/CPP protocol while PRx has remained unchanged.
Authors: Frederick A Zeiler; Ari Ercole; Erta Beqiri; Manuel Cabeleira; Eric P Thelin; Nino Stocchetti; Ewout W Steyerberg; Andrew I R Maas; David K Menon; Marek Czosnyka; Peter Smielewski Journal: J Neurotrauma Date: 2019-12-30 Impact factor: 5.269
Authors: Frederick A Zeiler; François Mathieu; Miguel Monteiro; Ben Glocker; Ari Ercole; Erta Beqiri; Manuel Cabeleira; Nino Stocchetti; Peter Smielewski; Marek Czosnyka; Virginia Newcombe; David K Menon Journal: J Neurotrauma Date: 2020-04-06 Impact factor: 5.269
Authors: Frederick A Zeiler; Erta Beqiri; Manuel Cabeleira; Peter J Hutchinson; Nino Stocchetti; David K Menon; Marek Czosnyka; Peter Smielewski; Ari Ercole Journal: J Neurotrauma Date: 2020-05-04 Impact factor: 5.269
Authors: Frederick A Zeiler; Marcel Aries; Manuel Cabeleira; Thomas A van Essen; Nino Stocchetti; David K Menon; Ivan Timofeev; Marek Czosnyka; Peter Smielewski; Peter Hutchinson; Ari Ercole Journal: J Neurotrauma Date: 2020-02-25 Impact factor: 5.269