Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-13T01:27:07.016Z Has data issue: false hasContentIssue false

Intracranial Pressure Monitoring in Severe Traumatic Brain Injury – Results of a Canadian Survey

Published online by Cambridge University Press:  04 August 2016

Ramesh Sahjpaul*
Affiliation:
Department of Clinical Neurological Sciences, London Health Sciences Center, London, Ontario
Murray Girotti
Affiliation:
Department of Clinical Neurological Sciences, London Health Sciences Center, London, Ontario
*
Department of Clinical Neurological Sciences, London Health Sciences Center, University Campus, 339 Windermere Rd, London, Ont N6A 5A5, Canada
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

The purpose of this study was to obtain information from Canadian neurosurgeons regarding their opinions on, and utilization of, intracranial pressure (ICP) monitoring for severe traumatic brain injury (TBI).

Methods:

A brief survey was sent to practicing Canadian neurosurgeons questioning them about their utilization of, and confidence in, intracranial pressure monitoring in the management of patients with severe TBI.

Results:

One hundred and ninety-six surveys were mailed. There were 103 responses for a response rate of 52.6%. The vast majority of responding neurosurgeons (98.1%) utilized ICP monitoring in the management of patients with severe TBI, with most (63.4%) using it in more than 75% of their patients, 14.9% using it in 50-75% of patients, 14.9% in 25-50% of patients, and 6.9% using it in less than 25% of patients. The level of confidence that routine monitoring improves outcome from severe TBI ranged from 23.3% having a low level of confidence, 56.3% having an intermediate level of confidence, to 20.4% having a high level of confidence. Most respondents (78.6%) felt that some form of prospective trial evaluating the role of ICP monitoring in improving outcome from severe TBI was warranted; 17.4% felt such a trial was not warranted and 3.9% were uncertain.

Conclusions:

While ICP monitoring has gained almost universal acceptance among responding Canadian neurosurgeons, their level of confidence that routine monitoring improves outcome from severe TBI was quite variable, with only 20.4% of respondents having a high level of confidence. Over 75% of respondents felt that some form of prospective trial evaluating the utility of ICP monitoring is warranted. This information is being used in consideration of a prospective trial addressing this issue.

Type
Original Article
Copyright
Copyright © The Canadian Journal of Neurological 2000

References

REFERENCES

1. Marion, DW, Firlik, K. Management of Severe Traumatic Brain Injury in 1997: The Impact of the Guidelines for the Management of Severe Head Injuries. AANS and CNS Joint Section on Neurotrauma and Critical Care. Summer/Fall 1997, p23.Google Scholar
2. Ghajar, JB, Hariri, R, Narayan, RK, et al. Survey of critical care management of comatose head injured patients in the United States. Crit Care Med 1995; 23:560567.Google Scholar
3. Chestnut, R. Implications of the Guidelines for the Management of Severe Head Injury for the practicing neurosurgeon. Surg Neurol 1998;50:187193.CrossRefGoogle Scholar
4. Bullock, R, Chestnut, R, Clifton, G, et al. Guidelines for the management of severe head injury. 1996; New York:Brain Trauma Foundation.Google Scholar
5. Jeevaratnam, DR, Menon, DK. Survey of intensive care of severely head injured patients in the United Kingdom. BMJ 1996;312(70360):944947.Google Scholar
6. Matta, B, Menon, D. Severe head injury in the United Kingdom and Ireland: a survey of practice and implications for management. Crit Care Med 1996;24(10):17431748.CrossRefGoogle Scholar
7. Lundberg, N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand Suppl 1960;149:1193.Google Scholar
8. Jennet, B, Teasdale, G, Galbraith, S, et al. Severe head injury in three countries. J Neurol Neurosurg Psychiatry 1977;40:291295.Google Scholar
9. Becker, DP, Miller, JD, Ward, JD, et al. The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 1977;47;491502.CrossRefGoogle ScholarPubMed
10. Marshall, LF, Smith, RW, Shapiro, HM. The outcome with aggressive treatment in severe head injuries Mannitol dose requirements in brain injured patients. J Neurosurg 1978;48;169172.Google Scholar
11. Saul, TG, Ducker, TB. Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg 1982;56:498503.Google Scholar
12. Eisenberg, HM, Gary, HE Jr, Aldrich, EF, et al. Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg 1990;73:688698.CrossRefGoogle ScholarPubMed
13. Colohan, AR, Alves, WM, Gross, CR, et al. Head injury mortality in two centers with different emergency medical services and intensive care. J Neurosurg 1989;71:202207.CrossRefGoogle ScholarPubMed
14. Ghajar, JB, Hariri, RJ, Patterson, RH. Improved outcome from traumatic coma using only ventricular CSF drainage for ICP control. Adv Neurosurg 1993;21:173177.Google Scholar
15. Marmorou, A, Anderson, RL, Ward, JD, et al. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 1991;75:S59–S66.Google Scholar
16. Stuart, GG, Merry, GS, Smith, JA, et al. Severe head injury managed without intracranial pressure monitoring. J Neurosurg 1983;59:601605.Google Scholar
17. Smith, HP, Kelly, DL Jr, McWhorter, JM, et al. Comparison of mannitol regimens in patients with severe head injury undergoing intracranial monitoring. J Neurosurg 1986;65;820824.Google Scholar
18. Bouma, GJ, Muizelaar, JP, Choi, SC, et al. Cerebral circulation and metabolism after severe traumatic brain injury: the elusive role of ischemia. J Neurosurg 1991;75:685693.Google Scholar
19. Bouma, GJ, Muizelaar, JP, Stringer, WA, et al. Ultra early evaluation of regional cerebral blood flow in severely head-injured patients using xenon enhanced computed tomography. J Neurosurg 1992;77:360368.Google Scholar
20. Jaggi, JL, Obrist, WD, Gennarelli, TA, et al. Relationship of early cerebral blood flow and metabolism to outcome in acute head injury. J Neurosurg 1990;72:176182.Google Scholar
21. Marion, DW, Darby, J, Yonal, H. Acute regional cerebral blood flow changes caused by severe head injuries. J Neurosurg 1991;74;407414.Google Scholar
22. Roberton, CS, Contant, CF Narayan, RK, et al. Cerebral blood flow, AVDO2, and neurologic outcome in head-injured patients. J Neurotrauma 1992;9:S349–S358.Google Scholar
23. Salvant, JB, Muizelaar, JP. Changes in cerebral blood flow and metabolism related to the presence of subdural hematoma. Neurosurgery 1993;33:387393.Google Scholar
24. Graham, DI, Ford, I, Adama, JH, et al. Ischaemic brain damage is still common in fatal non-missile head injury. J Neurol Neurosurg Psychiatry 1989;52;346350.CrossRefGoogle ScholarPubMed
25. Graham, DI, Lawrence, AE, Adams, JH, et al. Brain damage in fatal non-missile head injury without high intracranial pressure. J Clin Pathol 1988;41:3437.Google Scholar
26. Ross, DT, Graham, DI, Adams, JH, et al. Selective loss of neurons from the thalamic reticular nucleus following severe human head injury. J Neurotrauma 1993;10:151165.Google Scholar
27. Clifton, Gl, Allen, S, Barrodale, P, et al. A phase II study of moderate hypothermia in severe brain injury. J Neurotrauma 1993;10:263371.Google Scholar
28. Fortune, JB, Feustel, PJ, Weigle, CGM, et al. Continuous measurement of jugular venous oxygen saturation in response to transient elevations of blood pressure in head-injured patients. J Neurosurg 1994;80:461468.Google Scholar
29. Marion, DW, Obrist, WD, Carlier, PM, et al. The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report. J Neurosurg 1993;79:354362.CrossRefGoogle ScholarPubMed
30. Rosner, MJ, Daughton, S. Cerebral perfusion pressure management in head injury. J Trauma 1990;30;933941.Google Scholar
31. Yoshida, A, Shima, T, Okada, Y, et al. Outcome of patients with severe head injury-Evaluation by cerebral perfusion pressure, In: Nakamura, N, Hashiomoto, T, Yasue, M, eds.:Hong Kong: Springer-Verlag, 1993;309312.Google Scholar
32. Marshall, LF, Gautille, T, Klauber, MR, et al. The outcome of severe closed head injury. J Neurosurg 1991;75:S28–S36.Google Scholar
33. Eker, C, Asgeirsson, B, Per-Olof, Grande, et al. Improved outcome after severe head injury with a new therapy based on principles for brain volume regulation and preserved microcirculation. Crit Care Med 1998;26(11):18811886.CrossRefGoogle ScholarPubMed
34. Schneck, MJ. Treating elevated intracranial pressure: Do we raise or lower the blood pressure? Crit Care Med 1998;26(11):17871788.CrossRefGoogle ScholarPubMed