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CC BY-NC-ND 4.0 · Indian Journal of Neurotrauma 2020; 17(02): 121-129
DOI: 10.1055/s-0040-1713324
Original Article

Role of Intraoperative ICP And CPP Measurement for Predicting Surgical Outcome in Severe Traumatic Brain Injury

Ramesh Chandra VV
1   Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India
,
Chandra Mowliswara Prasad Bodapati
1   Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India
,
Rajesh Paradesi
1   Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India
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Abstract

Introduction Traumatic brain injury (TBI) is one of the leading causes of mortality and disability worldwide, and optimizing the management of these patients is a continuing challenge. Intraoperative intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were evaluated for use as prognostic indicators after surgery for severe TBI. Although ICP and CPP monitoring is standard postsurgery treatment for TBI, very few studies have reported the use of ICP and CPP values monitored during surgery.

Objectives The objectives of this study were to evaluate the use of intraoperative ICP and CPP values as prognostic indicators and as subjective guidelines for managing severe TBI.

Materials and Methods All patients with severe TBI who underwent surgical decompression and ICP monitoring intraoperatively were included in our study from 2017 to 2018. We measured ICP and CPP values after creation of the first burr hole, after hematoma evacuation, and after wound closure.

Results From the analysis of receiver-operated characteristic (ROC) curves, we observed that ICP initial (cutoff > 28 mm Hg) and CPP initial (cutoff < 44.5 mm Hg) are the best predictors of unfavorable outcomes. Favorable outcome (Glasgow outcome scale [GOS] 4 and 5) and unfavorable outcome (GOS 1–3) after 6 months were achieved in 64.1 and 35.8% of patients, respectively. There was significant difference between the ICP and CPP values which are measured after the first burrhole, after hematoma evacuation, and after scalp closure in both favorable and unfavorable outcomes. The highest positive Pearson’s correlation coefficient is found between GOS and ICP and CPP after first burr hole.

Conclusion Monitoring ICP and CPP during surgery improves management in patients with severe TBI and provides an early prognostic indicator in such patients.

Keywords

intracranial pressure - cerebral perfusion pressure - glasgow outcome scale - receiver–operating characteristic


Publikationsverlauf

Artikel online veröffentlicht:
20. August 2020

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Thieme Medical and Scientific Publishers Private Ltd.
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  • References

  • 1 Maas AIR, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol 2008; 7 (08) 728-741
    CrossrefPubMedGoogle Scholar
  • 2 Shen L, Wang Z, Su Z. et al. Effects of intracranial pressure monitoring on mortality in patients with severe traumatic brain injury: a meta-analysis. PLoS One 2016; 11 (12) e0168901
    Google Scholar
  • 3 Olivecrona M, Rodling-Wahlström M, Naredi S, Koskinen LO. Effective ICP reduction by decompressive craniectomy in patients with severe traumatic brain injury treated by an ICP-targeted therapy. J Neurotrauma 2007; 24 (06) 927-935
    CrossrefPubMedGoogle Scholar
  • 4 Cremer OL, van Dijk GW, van Wensen E. et al. Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med 2005; 33 (10) 2207-2213
    CrossrefPubMedGoogle Scholar
  • 5 Lundberg N, Troupp H, Lorin H. Continuous recording of the ventricular-fluid pressure in patients with severe acute traumatic brain injury. A preliminary report. J Neurosurg 1965; 22 (06) 581-590
    CrossrefPubMedGoogle Scholar
  • 6 Robertson CS, Valadka AB, Hannay HJ. et al. Prevention of secondary ischemic insults after severe head injury. Crit Care Med 1999; 27 (10) 2086-2095
    CrossrefPubMedGoogle Scholar
  • 7 Stein SC, Georgoff P, Meghan S. Mirza KL, El Falaky OM. Relationship of aggressive monitoring and treatment to improved outcomes in severe traumatic brain injury. J Neurosurg 2010; 112 (05) 1105-1112
    CrossrefPubMedGoogle Scholar
  • 8 Carney NA, Ghajar J. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS. J Neurotrauma 2007; 24 (Suppl. 01) S1-S106
    CrossrefPubMed
  • 9 Rosner MJ, Daughton S. Cerebral perfusion pressure management in head injury. J Trauma 1990; 30 (08) 933-940, discussion 940–941
    CrossrefPubMedGoogle Scholar
  • 10 Verweij BH, Muizelaar JP, Vinas FC. Hyperacute measurement of intracranial pressure, cerebral perfusion pressure, jugular venous oxygen saturation, and laser Doppler flowmetry, before and during removal of traumatic acute subdural hematoma. J Neurosurg 2001; 95 (04) 569-572
    CrossrefPubMedGoogle Scholar
  • 11 Jaeger M, Soehle M, Meixensberger J. Effects of decompressive craniectomy on brain tissue oxygen in patients with intracranial hypertension. J Neurol Neurosurg Psychiatry 2003; 74 (04) 513-515
    CrossrefPubMedGoogle Scholar
  • 12 Schneider GH, Bardt T, Lanksch WR, Unterberg A. Decompressive craniectomy following traumatic brain injury: ICP, CPP and neurological outcome. Acta Neurochir Suppl (Wien) 2002; 81: 77-79
    PubMedGoogle Scholar
  • 13 Kunze E, Meixensberger J, Janka M, Sörensen N, Roosen K. Decompressive craniectomy in patients with uncontrollable intracranial hypertension. Acta Neurochir Suppl (Wien) 1998; 71: 16-18
    PubMedGoogle Scholar
  • 14 Huang SJ, Hong WC, Han YY. et al. Clinical outcome of severe head injury using three different ICP and CPP protocol-driven therapies. J Clin Neurosci 2006; 13 (08) 818-822
    CrossrefPubMedGoogle Scholar
  • 15 Kuo J-R, Yeh T-C, Sung K-C, Wang CC, Chen CW, Chio CC. Intraoperative applications of intracranial pressure monitoring in patients with severe head injury. J Clin Neurosci 2006; 13 (02) 218-223
    CrossrefPubMedGoogle Scholar
  • 16 Chambers IR, Treadwell L, Mendelow AD. Determination of threshold levels of cerebral perfusion pressure and intracranial pressure in severe head injury by using receiver-operating characteristic curves: an observational study in 291 patients. J Neurosurg 2001; 94 (03) 412-416
    CrossrefPubMedGoogle Scholar
  • 17 Low D, Kuralmani V, Ng SK, Lee KK, Ng I, Ang BT. Prediction of outcome utilizing both physiological and biochemical parameters in severe head injury. J Neurotrauma 2009; 26 (08) 1177-1182
    CrossrefPubMedGoogle Scholar
  • 18 Bratton SL, Chestnut RM, Ghajar J. et al. Brain Trauma Foundation, American Association of Neurological Surgeons , Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds. J Neurotrauma 2007; 24 (Suppl. 01) S55-S58
    CrossrefPubMedGoogle Scholar
  • 19 Tsai TH, Huang TY, Kung SS, Su YF, Hwang SL, Lieu AS. Intraoperative intracranial pressure and cerebral perfusion pressure for predicting surgical outcome in severe traumatic brain injury. Kaohsiung J Med Sci 2013; 29 (10) 540-546
    CrossrefPubMedGoogle Scholar
  • 20 Downard C, Hulka F, Mullins RJ. et al. Relationship of cerebral perfusion pressure and survival in pediatric brain-injured patients. J Trauma 2000; 49 (04) 654-658, discussion 658–659
    CrossrefPubMedGoogle Scholar
  • 21 Jiang JY, Gao GY, Li WP, Yu MK, Zhu C. Early indicators of prognosis in 846 cases of severe traumatic brain injury. J Neurotrauma 2002; 19 (07) 869-874
    CrossrefPubMedGoogle Scholar
  • 22 Wardlaw JM, Easton VJ, Statham P. Which CT features help predict outcome after head injury?. J Neurol Neurosurg Psychiatry 2002; 72 (02) 188-192, discussion 151
    CrossrefPubMedGoogle Scholar