Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring Clinical article
Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring Clinical article
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DOI：
10.3171/2012.7.jns111816
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发表时间：
2012-10-01
影响因子：
4.1
通讯作者：
Ghajar, Jamshid
中科院分区：
文献类型：
--
作者：
Farahvar, Arash;Gerber, Linda M.;Ghajar, Jamshid
Object.循证指南建议对重度创伤性脑损伤（TBI）患者进行颅内压（ICP）监测，但监测和治疗颅内高压可降低死亡率的证据有限。本研究使用了一个大型的前瞻性收集的数据库，以检查ICP降低治疗的严重TBI患者的2周死亡率的影响，无论是有或没有ICP监测。在2134例重度TBI患者（格拉斯哥昏迷量表[GCS]评分< 9）中，1446例患者接受了降低ICP治疗。其中，1202人插入了ICP监测仪，244人在没有监测的情况下接受了治疗。患者被收治到20个一级和两个二级创伤中心之一，这是2000年至2009年脑创伤基金会管理的纽约州质量改进计划的一部分。该数据库还包含已知的独立的早期死亡预后指标的信息，包括年龄，入院GCS评分，瞳孔状态，CT扫描结果，和复发。年龄、初始GCS评分、低血压和CT扫描结果与2周死亡率相关。此外，在调整独立影响死亡率的参数后，所有年龄段的患者中，与未使用ICP监测仪的患者相比，使用ICP监测仪治疗的患者2周死亡率较低（p = 0.02）。在接受颅内高压治疗的重度TBI患者中，与未使用ICP监测仪治疗的患者相比，使用ICP监测仪与死亡率显著降低相关。基于这些发现，作者得出结论，重度TBI患者的ICP导向治疗应通过ICP监测进行指导。(http：//thejns.org/doi/abs/10.3171/2012.7.JNS111816）
Object. Evidence-based guidelines recommend intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury (TBI), but there is limited evidence that monitoring and treating intracranial hypertension reduces mortality. This study uses a large, prospectively collected database to examine the effect on 2-week mortality of ICP reduction therapies administered to patients with severe TBI treated either with or without an ICP monitor.Methods. From a population of 2134 patients with severe TBI (Glasgow Coma Scale [GCS] Score < 9), 1446 patients were treated with ICP-lowering therapies. Of those, 1202 had an ICP monitor inserted and 244 were treated without monitoring. Patients were admitted to one of 20 Level I and two Level II trauma centers, part of a New York State quality improvement program administered by the Brain Trauma Foundation between 2000 and 2009. This database also contains information on known independent early prognostic indicators of mortality, including age, admission GCS score, pupillary status, CT scanning findings, and hypotension.Results. Age, initial GCS score, hypotension, and CT scan findings were associated with 2-week mortality. In addition, patients of all ages treated with an ICP monitor in place had lower mortality at 2 weeks (p = 0.02) than those treated without an ICP monitor, after adjusting for parameters that independently affect mortality.Conclusions. In patients with severe TBI treated for intracranial hypertension, the use of an ICP monitor is associated with significantly lower mortality when compared with patients treated without an ICP monitor. Based on these findings, the authors conclude that ICP-directed therapy in patients with severe TBI should be guided by ICP monitoring. (http://thejns.org/doi/abs/10.3171/2012.7.JNS111816)