scholarly journals Intracranial pressure monitoring, cerebral perfusion pressure estimation, and ICP/CPP-guided therapy: a standard of care or optional extra after brain injury?

2014 ◽  
Vol 112 (1) ◽  
pp. 35-46 ◽  
Author(s):  
M.A. Kirkman ◽  
M. Smith
Keyword(s):  
Brain Injury ◽  
Intracranial Pressure ◽  
Cerebral Perfusion Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Standard Of Care ◽  
Intracranial Pressure Monitoring ◽  
Pressure Monitoring ◽  
Optional Extra ◽  
Guided Therapy

scholarly journals Study of Intracranial Pressure Monitoring In Traumatic Brain Injury

2018 ◽  
Vol 15 (2) ◽  
pp. 23-29
Author(s):  
Nilam Khadka ◽  
Rajan Kumar Sharma ◽  
Rajiv Jha ◽  
Prakash Bista
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Fiber Optic ◽  
Standard Of Care ◽  
Intracranial Pressure Monitoring ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Serious Adverse Events ◽  
Monitoring Modality

Intracranial pressure monitoring is considered the standard of care for severe traumatic brain injury and is used frequently. However, the efficacy of treatment based on monitoring in improving the outcome has not been rigorously assessed. We conducted a trial in which we included 26 patients of all types of traumatic brain injury (TBI) and they were monitored for intracranial pressure by Conventional fluid filled system with a manometer (Group 1) and compared with the Fiber optic transducer-tipped intracranial pressure monitoring system (Group 2).The main aim of this study was to examine the relationship between Intracranial Pressure (ICP) monitoring and in-hospital mortality. The median length of stay in the ICU was similar in the two groups (12 days in the conventional pressure-monitoring group and 9 days in the new fiber optic group; P=0.25), the number of days of brain-specific treatments (e.g., administration of hyperosmolar fluids and the use of hyperventilation) in the ICU was similar in both groups. The distribution of serious adverse events was similar in the two groups. We concluded that ICP monitoring (as is any monitoring modality) is a useful guide for management. The outcomes are decided by the differences in management protocols that the knowledge of the said parameter brings about. ICP monitoring is recommended for the better management of traumatic brain injury and fiber optic ICP monitoring seems to be beneficial than using the conventional methods of ICP monitoring with manometer.Nepal Journal of Neuroscience, Volume 15, Number 2, 2018, page: 23-29

Intracranial Pressure and Cerebral Perfusion Pressure Monitoring in Non-TBI Patients: Special Considerations

2014 ◽  
Vol 21 (S2) ◽  
pp. 85-94 ◽  
Author(s):  
Raimund Helbok ◽  
◽  
DaiWai M. Olson ◽  
Peter D. Le Roux ◽  
Paul Vespa
Keyword(s):  
Intracranial Pressure ◽  
Cerebral Perfusion Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Pressure Monitoring

scholarly journals Brain Temperature Influences Intracranial Pressure and Cerebral Perfusion Pressure After Traumatic Brain Injury: A CENTER TBI Study

2020 ◽  
Author(s):  
Tatiana Birg ◽  
Fabrizio Ortolano ◽  
Eveline J.A. Wiegers ◽  
Peter Smielewski ◽  
Yan Savchenko ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Cerebral Perfusion Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Brain Temperature ◽  
Mixed Effects ◽  
Wilcoxon Test ◽  
Brain Physiology

Abstract BackgroundAfter Traumatic Brain Injury (TBI) fever is frequent. Brain temperature, which is directly linked to body temperature, may influence brain physiology. Increased body and/or brain temperature may cause secondary brain damage, with deleterious effects on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and outcome. MethodsCENTER-TBI, a prospective, multicenter, longitudinal study on TBI in Europe and Israel, includes a high resolution (HR) cohort of patients with data sampled at high-frequency (from 100 Hz to 500 Hz). In this study, simultaneous BT, ICP and CPP recordings were investigated. A mixed effects linear model was used to examine the association between different BT levels and ICP. We additionally focused on changes of ICP and CPP during the episodes of BT changes (delta BT ≥0.5 °C, lasting from 15 minutes to 3 hours) up or down-wards. The significance of ICP and CPP variations was estimated with the paired samples Wilcoxon test. Results Twenty-one patients with 2435 hours of simultaneous BT and ICP monitoring were studied. All patients reached a BT of 38° and experienced at least one episode of ICP above 20 mmHg. The linear mixed effects model revealed an association between BT above 37.5°C and higher ICP levels that was not confirmed for lower BT. We identified 149 episodes of BT changes. During BT elevations (n=79) ICP increased while CPP was reduced; opposite ICP and CPP variations occurred during episodes of BT reduction (n=70). All these changes were of moderate clinical relevance, even if statistically significant (p<0.0001). It has to be noted, however, that a number of therapeutic interventions against intracranial hypertension was documented during those episodes.ConclusionPatients after TBI usually develop BT> 38° soon after the injury. Brain temperature may influence brain physiology, as reflected by ICP and CPP. An association between BT exceeding 37.5°C and a higher ICP was identified. The relationship between BT, ICP and CPP become clearer during rapid temperature changes.Trial registration: The core study was registered with ClinicalTrials.gov, number NCT02210221, registered on July 29, 2014

Central Nervous System Injury

2017 ◽  
Author(s):  
Brandon R Bruns ◽  
Deborah M Stein
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Perfusion Pressure ◽  
Intracranial Pressure Monitoring ◽  
Pressure Monitoring ◽  
Cerebral Contusion ◽  
Different Types ◽  
Hospital Visits

Traumatic brain injury (TBI) accounts for 2.5 million hospital visits annually and is the leading cause of death and disability in patients age 1 to 44 years. Evaluation of patients with suspected TBI requires prompt physical examination with a focus on calculation of the Glasgow Coma Score and pupillary examination as early treatments can be initiated at this stage in patient management. Diagnostic studies include basic laboratory parameters and prompt evaluation with brain computed tomography to identify space-occupying lesions (blood) within the rigid calvarium. Distinction between the different types of traumatic intracerebral hemorrhage is imperative and enables prompt neurosurgical consultation, as well as initiation of appropriate medical therapies to treat elevated intracranial pressure and maintain cerebral perfusion pressure. Paramount in managing patients with suspected TBI is the avoidance of hypotension and hypoxia. Intracranial pressure monitoring remains controversial but is a cornerstone in TBI management. Patients with TBI may have lifelong complications and require careful follow-up. Many new prognostic tools are currently available. This review contains 4 figures, 4 tables, and 47 references. Key words: cerebral contusion, epidural hematoma, intracranial pressure monitoring, subdural hematoma, traumatic brain injury 

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