Table 15.1 Intracranial Pressure Monitors for the Acute Management of Intracranial Pressure Post ABI
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Author Year Country Research Design PEDro Sample Size |
Methods | Outcomes |
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Chesnut et al. (2012) Bolivia& Ecuador RCT PEDro=8 N=324 |
Population: TBI=200. Pressure-monitoring group (n=157): Median Age=29 yr; Gender: Male=143, Female=14. Median time to admission to study hospital= 3.5 h. Median motor GCS score=5. Imaging-Clinical Examination (ICE) group (n=167): Mean Age=29 yr; Gender: Male=140, Female=27, Median time to admission to study hospital=2.9 h, Median motor GCS score=4. Intervention: Patients were randomly assigned to either the ICP-monitoring, or the Imaging and Clinical Examination (ICE) group. Patients in the ICP-monitoring group had an intraparenchymal monitor placed as soon as possible. Patients in the ICE group were treated in accordance to hospital protocol. Outcomes were assessed at discharge, 3 and 6 mo. Outcome measures: Survival, Duration and Level of Impaired Consciousness, Functional Status and Orientation (3mo- GOSE, DSR, GOAT), Functional and Neuropsychological Status (6 mo), Hospital Length of Stay (LOS), Systemic Complications. | 1. There were no significant differences between the groups in survival, 14 d or 6 mo mortality, hospital LOS, incidence of neurological worsening. 2. Patients in the pressure-monitoring group had a significant higher rate of decubitus ulcers compared to the ICE group (p=0.03) 3. The median interval during which patients received brain-specific treatment, total number of treatments, use of high dose barbiturates, and proportion of patients treated with HTS or hyperventilation was significantly higher in the ICE group (p=0.05) |
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Agrawal et al. (2017) USA & India Cohort N=1345 |
Population: Severe TBI; ICPM not used (n=848): Median Age=32 yr; Gender: Male=756, Female=92; Median Time Post Injury=3.46 hr; Median Admission GCS=6. ICPM used (n=497): Median Age=31 yr; Gender: Male=438, Female=59; Median Time Post Injury=3.08 hr; Median Admission GCS=7. Intervention: Patients who received invasive intracranial pressure monitoring (ICPM) during ICU admission were compared with controls. Outcome Measures: Hospital Mortality, Glasgow Outcome Scale (GOS). | 1. The probability of hospital mortality was significantly lower in patients who received ICPM by about 9% (p=0.001). ICPM utilization was also associated with a significantly lower mortality at 6mo by about 6% (p=0.03). 2. There were no significant treatment effects on probability of poor function (defined by GOS) at 6mo (p=0.46). |
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Kasotakis et al. (2012) USA Case Control N=377 |
Population: TBI; Mean Age=46.5 yr; Gender: Male=295, Female=83; Mean GCS=6.7. Intervention: Participants who received External Ventricular Drainage (EVD) or Intraparenchymal Fiberoptic Monitor (IPM) for CSF drainage were compared. Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Scale (GOS), Mortality, Length of Stay (LOS), Additional Treatments, Complications. | 1. Mean ICP monitoring duration was significantly longer in EVD than IPM (7.3 days versus 3.8 days, p<0.001). 2. There was no significant difference between EVD and IPM in mean GOS at 1 mo (2.5 versus 2.7, p=0.45) or mortality (32.2% versus 20.9%, p=0.82). 3. Mean LOS in ICU was significantly longer in EVD than IPM (9.5 days versus 7.6, p=0.004), but there was no difference in hospital LOS (16.4 days versus 15.6 days, p=0.57). 4. Surgical decompression was significantly higher in EVD than IPM (51.9% versus 33.6%, p=0.001). 5. Device-related complications were significantly higher in the EVD group than in the IPM group (31.1% versus 11.2%, p<0.05). |