Cargando…
Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study
BACKGROUND: Intracranial pressure (ICP) monitoring is widely used in the management of patients with severe traumatic brain injury (TBI). However, there is limited evidence about the efficacy of ICP monitoring in older subjects (aged ≥65 years). This study evaluated the effect of intraventricular IC...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940906/ https://www.ncbi.nlm.nih.gov/pubmed/27401211 http://dx.doi.org/10.1186/s12871-016-0199-9 |
_version_ | 1782442218069426176 |
---|---|
author | You, Wendong Feng, Junfeng Tang, Qilin Cao, Jun Wang, Lei Lei, Jin Mao, Qing Gao, Guoyi Jiang, Jiyao |
author_facet | You, Wendong Feng, Junfeng Tang, Qilin Cao, Jun Wang, Lei Lei, Jin Mao, Qing Gao, Guoyi Jiang, Jiyao |
author_sort | You, Wendong |
collection | PubMed |
description | BACKGROUND: Intracranial pressure (ICP) monitoring is widely used in the management of patients with severe traumatic brain injury (TBI). However, there is limited evidence about the efficacy of ICP monitoring in older subjects (aged ≥65 years). This study evaluated the effect of intraventricular ICP monitoring on the outcome of older adults suffering from a severe TBI. METHODS: This prospective, observational study included 166 older TBI patients (aged ≥65 years) with Glasgow Coma scale (GCS) scores lower than 9 at admission. The study cohort was divided into two groups, intraventricular ICP monitoring and non-ICP monitoring. The primary outcome was in-hospital mortality. The secondary outcomes included the Glasgow Outcome Scale (GOS) score 6 months after injury, the ICU and total hospital lengths of stay, and mechanical ventilation days. RESULTS: There were 80 patients in the intraventricular ICP monitoring group and 86 patients in non-ICP monitoring group. There was no statistical difference between groups in demographics and severity of head injury. Patients treated with intraventricular ICP monitoring had lower in-hospital mortality (33.8 % vs 51.2 %, P < 0.05), a higher 6-month GOS score (3.0 ± 1.4 vs 2.5 ± 1.2 P < 0.05), and a lower dosage (514 ± 246 g vs 840 ± 323 g, P < 0.0001) and shorter duration (7.2 ± 3.6 days vs 8.4 ± 4.3 days, P < 0.01) of mannitol use. However, the ICU length of stay (14.3 ± 6.4 days vs 11.6 ± 5.8 days, P < 0.01) and mechanical ventilation days (6.7 ± 3.5 days vs 5.6 ± 2.4 days, P < 0.05) were longer in the ICP monitoring group. The total length of hospital stay did not differ between the two groups (28.5 ± 12.1 days vs 26.1 ± 13.5 days, P = 0.23). CONCLUSIONS: Intraventricular ICP monitoring may have beneficial effects on the decreased in-hospital mortality and improved 6-month outcome of older patients with severe TBI. However, given that this was an observational study conducted in a single institution, further well-designed randomized control trials are needed to evaluate the effect of intraventricular ICP monitoring on the outcome of older severe TBI patients. |
format | Online Article Text |
id | pubmed-4940906 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-49409062016-07-13 Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study You, Wendong Feng, Junfeng Tang, Qilin Cao, Jun Wang, Lei Lei, Jin Mao, Qing Gao, Guoyi Jiang, Jiyao BMC Anesthesiol Research Article BACKGROUND: Intracranial pressure (ICP) monitoring is widely used in the management of patients with severe traumatic brain injury (TBI). However, there is limited evidence about the efficacy of ICP monitoring in older subjects (aged ≥65 years). This study evaluated the effect of intraventricular ICP monitoring on the outcome of older adults suffering from a severe TBI. METHODS: This prospective, observational study included 166 older TBI patients (aged ≥65 years) with Glasgow Coma scale (GCS) scores lower than 9 at admission. The study cohort was divided into two groups, intraventricular ICP monitoring and non-ICP monitoring. The primary outcome was in-hospital mortality. The secondary outcomes included the Glasgow Outcome Scale (GOS) score 6 months after injury, the ICU and total hospital lengths of stay, and mechanical ventilation days. RESULTS: There were 80 patients in the intraventricular ICP monitoring group and 86 patients in non-ICP monitoring group. There was no statistical difference between groups in demographics and severity of head injury. Patients treated with intraventricular ICP monitoring had lower in-hospital mortality (33.8 % vs 51.2 %, P < 0.05), a higher 6-month GOS score (3.0 ± 1.4 vs 2.5 ± 1.2 P < 0.05), and a lower dosage (514 ± 246 g vs 840 ± 323 g, P < 0.0001) and shorter duration (7.2 ± 3.6 days vs 8.4 ± 4.3 days, P < 0.01) of mannitol use. However, the ICU length of stay (14.3 ± 6.4 days vs 11.6 ± 5.8 days, P < 0.01) and mechanical ventilation days (6.7 ± 3.5 days vs 5.6 ± 2.4 days, P < 0.05) were longer in the ICP monitoring group. The total length of hospital stay did not differ between the two groups (28.5 ± 12.1 days vs 26.1 ± 13.5 days, P = 0.23). CONCLUSIONS: Intraventricular ICP monitoring may have beneficial effects on the decreased in-hospital mortality and improved 6-month outcome of older patients with severe TBI. However, given that this was an observational study conducted in a single institution, further well-designed randomized control trials are needed to evaluate the effect of intraventricular ICP monitoring on the outcome of older severe TBI patients. BioMed Central 2016-07-11 /pmc/articles/PMC4940906/ /pubmed/27401211 http://dx.doi.org/10.1186/s12871-016-0199-9 Text en © You et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article You, Wendong Feng, Junfeng Tang, Qilin Cao, Jun Wang, Lei Lei, Jin Mao, Qing Gao, Guoyi Jiang, Jiyao Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study |
title | Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study |
title_full | Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study |
title_fullStr | Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study |
title_full_unstemmed | Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study |
title_short | Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study |
title_sort | intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940906/ https://www.ncbi.nlm.nih.gov/pubmed/27401211 http://dx.doi.org/10.1186/s12871-016-0199-9 |
work_keys_str_mv | AT youwendong intraventricularintracranialpressuremonitoringimprovestheoutcomeofolderadultswithseveretraumaticbraininjuryanobservationalprospectivestudy AT fengjunfeng intraventricularintracranialpressuremonitoringimprovestheoutcomeofolderadultswithseveretraumaticbraininjuryanobservationalprospectivestudy AT tangqilin intraventricularintracranialpressuremonitoringimprovestheoutcomeofolderadultswithseveretraumaticbraininjuryanobservationalprospectivestudy AT caojun intraventricularintracranialpressuremonitoringimprovestheoutcomeofolderadultswithseveretraumaticbraininjuryanobservationalprospectivestudy AT wanglei intraventricularintracranialpressuremonitoringimprovestheoutcomeofolderadultswithseveretraumaticbraininjuryanobservationalprospectivestudy AT leijin intraventricularintracranialpressuremonitoringimprovestheoutcomeofolderadultswithseveretraumaticbraininjuryanobservationalprospectivestudy AT maoqing intraventricularintracranialpressuremonitoringimprovestheoutcomeofolderadultswithseveretraumaticbraininjuryanobservationalprospectivestudy AT gaoguoyi intraventricularintracranialpressuremonitoringimprovestheoutcomeofolderadultswithseveretraumaticbraininjuryanobservationalprospectivestudy AT jiangjiyao intraventricularintracranialpressuremonitoringimprovestheoutcomeofolderadultswithseveretraumaticbraininjuryanobservationalprospectivestudy |