| Automated measurement of "pressure times time dose" of intracranial hypertension best predicts outcome after severe traumatic brain injury. | |
| | |
MedLine Citation:
|
PMID: 20038855 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Earlier, more accurate assessment of secondary brain injury is essential in management of patients with traumatic brain injury (TBI). We assessed the accuracy and utility of high-resolution automated intracranial pressure (ICP) and cerebral perfusion pressure (CPP) recording and their analysis in patients with severe TBI. METHODS: ICP and CPP data for 30 severe TBI patients were collected automatically at 6-second intervals. The degree and duration of ICP and CPP above and below treatment thresholds were calculated as "pressure times time dose" (PTD; mm Hg . h) using automated recordings (PTDa) or manual recordings (PTDm) for early stage (trauma resuscitation unit [TRU]) and total monitoring time (TRU and intensive care unit). RESULTS: Bland-Altman plots showed lack of agreement between PTDa and PTDm. For ICP >20 mm Hg and CPP <60 mm Hg, PTDa, but not PTDm, was significantly higher in patients with unfavorable outcome (Extended Glasgow Outcome Scale score <or=4) than in patients with favorable outcome (Extended Glasgow Outcome Scale score >4). Total PTDa for ICP >20 mm Hg and CPP <60 mm Hg had high predictive power for functional outcome (area under the receiver operating characteristics curve: 0.92 +/- 0.05 and 0.82 +/- 0.08, respectively) and inhospital mortality (0.76 +/- 0.15 and 0.79 +/- 0.14, respectively) and were strongly correlated with length of intensive care unit stay (p = 0.009 and 0.007), length of hospital stay (p = 0.009 and 0.005), and discharge Glasgow Coma Scale scores (p = 0.008 and p = 0.038). PTDa of CPP >100 mm Hg during TRU monitoring and during the first 24 hours showed highest predictive power for mortality (area under the receiver operating characteristics curve: 0.72 +/- 0.18 and 0.85 +/- 0.13, respectively). PTDa was better than PTDm and the duration of episodes alone in predicting outcome. CONCLUSIONS: PTD calculation of high resolution ICP and CPP recording is a reliable and feasible way of monitoring severe TBI patients. |
| | |
Authors:
|
Sibel Kahraman; Richard P Dutton; Peter Hu; Yan Xiao; Bizhan Aarabi; Deborah M Stein; Thomas M Scalea |
Related Documents
:
|
18514825 - Management of intracranial hypertension. 11889475 - Diagnosis and management of increased intracranial pressure. 23347915 - Eustachian tube pressure equilibration. temporal analysis of pressure changes based on ... 21508715 - The prevalence of asymptomatic and symptomatic peripheral arterial disease and peripher... 18514825 - Management of intracranial hypertension. 9691675 - Modeling of parenteral container headspace pressure. |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: The Journal of trauma Volume: 69 ISSN: 1529-8809 ISO Abbreviation: J Trauma Publication Date: 2010 Jul |
Date Detail:
|
Created Date: 2010-07-12 Completed Date: 2010-08-03 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
|
Languages: eng Pagination: 110-8 Citation Subset: AIM; IM |
Affiliation:
|
Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Brain Injuries / complications, diagnosis, physiopathology* Female Humans Intensive Care / methods Intracranial Hypertension / etiology*, physiopathology Length of Stay Male Monitoring, Physiologic / methods Prognosis Statistics, Nonparametric Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Preliminary report: resection and interposition of a deepithelialized skin flap graft in tarsal coal...
Next Document: Simplified Estimates of the Probability of Death After Burn Injuries: Extending and Updating the Bau...