Journal ArticleDOI
Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury.
Marcel J. H. Aries,Marek Czosnyka,Karol P. Budohoski,Luzius A. Steiner,Andrea Lavinio,Angelos G. Kolias,Peter J. Hutchinson,Kenneth Martin Brady,David K. Menon,John D. Pickard,Peter Smielewski +10 more
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TLDR
Developing an automated methodology for the continuous updating of optimal cerebral perfusion pressure (CPPopt) for patients after severe traumatic head injury, using continuous monitoring of cerebrovascular pressure reactivity is sought.Abstract:
Objectives: We have sought to develop an automated methodology for the continuous updating of optimal cerebral perfusion pressure (CPPopt) for patients after severe traumatic head injury, using continuous monitoring of cerebrovascular pressure reactivity. We then validated the CPPopt algorithm by determining the association between outcome and the deviation of actual CPP from CPPopt. Design: Retrospective analysis of prospectively collected data. Setting: Neurosciences critical care unit of a university hospital. Patients: A total of 327 traumatic head-injury patients admitted between 2003 and 2009 with continuous monitoring of arterial blood pressure and intracranial pressure. Measurements and Main Results: Arterial blood pressure, intracranial pressure, and CPP were continuously recorded, and pressure reactivity index was calculated online. Outcome was assessed at 6 months. An automated curve fitting method was applied to determine CPP at the minimum value for pressure reactivity index (CPPopt). A time trend of CPPopt was created using a moving 4-hr window, updated every minute. Identification of CPPopt was, on average, feasible during 55% of the whole recording period. Patient outcome correlated with the continuously updated difference between median CPP and CPPopt (chi-square = 45, p CPPopt), and favorable outcome was associated with smaller deviations of CPP from the individualized CPPopt. While deviations from global target CPP values of 60 mm Hg and 70 mm Hg were also related to outcome, these relationships were less robust. Conclusions: Real-time CPPopt could be identified during the recording time of majority of the patients. Patients with a median CPP close to CPPopt were more likely to have a favorable outcome than those in whom median CPP was widely different from CPPopt. Deviations from individualized CPPopt were more predictive of outcome than deviations from a common target CPP. CPP management to optimize cerebrovascular pressure reactivity should be the subject of future clinical trial in severe traumatic head-injury patients. (Crit Care Med 2012; 40:2456-2463)read more
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Journal ArticleDOI
A Trial of Intracranial-Pressure Monitoring in Traumatic Brain Injury
Randall M. Chesnut,Nancy R. Temkin,Nancy Carney,Sureyya Dikmen,Carlos Rondina,Walter Videtta,Gustavo Petroni,Silvia Lujan,James S. Pridgeon,Jason Barber,Joan Machamer,Kelley Chaddock,Juanita M. Celix,Marianna Cherner,Terence Hendrix +14 more
TL;DR: For patients with severe traumatic brain injury, care focused on maintaining monitored intracranial pressure at 20 mm Hg or less was not shown to be superior to care based on imaging and clinical examination.
Journal ArticleDOI
Consensus Summary Statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care : A statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine
Peter D. Le Roux,David K. Menon,Giuseppe Citerio,Paul M. Vespa,Mary Kay Bader,Gretchen M. Brophy,Michael N. Diringer,Nino Stocchetti,Walter Videtta,Rocco Armonda,Neeraj Badjatia,Julian J. Böesel,Randall M. Chesnut,Sherry Chou,Jan Claassen,Marek Czosnyka,Michael De Georgia,Anthony A. Figaji,Jennifer E. Fugate,Raimund Helbok,David A. Horowitz,Peter Hutchinson,Monisha A. Kumar,Molly McNett,Chad Miller,Andrew M. Naidech,Mauro Oddo,DaiWai M. Olson,Kristine O’Phelan,J. Javier Provencio,Corinna Puppo,Richard R. Riker,Claudia S. Robertson,Michael Schmidt,Fabio Silvio Taccone +34 more
TL;DR: International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neuro critical care.
Journal ArticleDOI
A trial of intracranial pressure monitoring in traumatic brain injury
TL;DR: For patients with severe TBI, care focused on maintaining monitored ICP at 20 mmHg or less was not shown to be superior to care based on imaging and clinical examination.
Journal ArticleDOI
Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care : a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine.
Peter D. Le Roux,David K. Menon,Giuseppe Citerio,Paul M. Vespa,Mary Kay Bader,Gretchen M. Brophy,Michael N. Diringer,Nino Stocchetti,Walter Videtta,Rocco Armonda,Neeraj Badjatia,Julian J. Böesel,Randall M. Chesnut,Sherry Chou,Jan Claassen,Marek Czosnyka,Michael De Georgia,Anthony A. Figaji,Jennifer E. Fugate,Raimund Helbok,David A. Horowitz,Peter Hutchinson,Monisha A. Kumar,Molly McNett,Chad Miller,Andrew M. Naidech,Mauro Oddo,DaiWai M. Olson,Kristine O’Phelan,J. Javier Provencio,Corinna Puppo,Richard R. Riker,Claudia S. Robertson,Michael Schmidt,Fabio Silvio Taccone +34 more
TL;DR: International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neuro critical care.
Journal ArticleDOI
Severe traumatic brain injury: targeted management in the intensive care unit
Nino Stocchetti,Nino Stocchetti,Marco Carbonara,Giuseppe Citerio,Ari Ercole,Markus B. Skrifvars,Markus B. Skrifvars,Peter Smielewski,Tommaso Zoerle,David K. Menon +9 more
TL;DR: Progress in monitoring and in understanding pathophysiological mechanisms of TBI could change current management in the intensive care unit, enabling targeted interventions that could ultimately improve outcomes.
References
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ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE: A Practical Scale
Bryan Jennett,Michael R. Bond +1 more
TL;DR: In this article, a five-point scale is described, which includes death, persistent vegetative state, severe disability, moderate disability, and good recovery, and duration as well as intensity of disability should be included in an index of ill-health.
Journal ArticleDOI
Cerebral perfusion pressure: management protocol and clinical results
TL;DR: These results are significantly better than other reported series across GCS categories in comparisons of death rates, survival versus dead or vegetative, or favorable versus nonfavorable outcome classifications.
Journal ArticleDOI
Continuous assessment of the cerebral vasomotor reactivity in head injury
Marek Czosnyka,Piotr Smielewski,Peter J. Kirkpatrick,Rodney J. Laing,David K. Menon,John D. Pickard +5 more
TL;DR: Computer analysis of slow waves in ABP and ICP is able to provide a continuous index of cerebrovascular reactivity to changes in arterial pressure, which is of prognostic significance.
Journal ArticleDOI
Cerebral circulation and metabolism after severe traumatic brain injury: the elusive role of ischemia.
TL;DR: The results support the hypothesis that early ischemia after traumatic brain injury may be an important factor determining neurological outcome, and suggest that early hyperventilation or lowering of blood pressure to prevent brain edema may be harmful.