Year in review in Intensive Care Medicine 2012: I. Neurology and neurointensive care, epidemiology and nephrology, biomarkers and inflammation, nutrition, experimentals.
Year in review in Intensive Care Medicine 2012: I. Neurology and neurointensive care, epidemiology and nephrology, biomarkers and inflammation, nutrition, experimentals.
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DOI：
10.1007/s00134-012-2774-y
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发表时间：
2013-02
影响因子：
38.9
通讯作者：
Zhang, Haibo
中科院分区：
文献类型：
--
作者：
Antonelli, Massimo;Bonten, Marc;Cecconi, Maurizio;Chastre, Jean;Citerio, Giuseppe;Conti, Giorgio;Curtis, J. Randall;Hedenstierna, Goran;Joannidis, Michael;Macrae, Duncan;Maggiore, Salvatore M.;Mancebo, Jordi;Mebazaa, Alexandre;Preiser, Jean-Charles;Rocco, Patricia;Timsit, Jean-Francois;Wernerman, Jan;Zhang, Haibo
从那时起，20 mmHg的临界点被选为神经创伤学中最具指示性的临界点。不仅是超过阈值的时间，而且对治疗的反应也至关重要。根据这一概念，Treggiari [2]系统地回顾了文献，以估计ICP模式与结局之间的关联。与Marmarou的观察结果一致，ICP升高，即ICP [20 mmHg]与死亡概率增加相关。此外，如果颅内压升高但可治疗，这种情况与死亡或神经功能不良结局的可能性增加3倍至4倍相关。如果ICP升高且难治性，则与相对死亡风险显著增加相关（OR 114.3）。因此，难治性ICP和对ICP治疗的反应可能比绝对ICP值更好地预测神经系统结局。Badri等人[3]研究了颅内压升高是否与成人TBI患者的死亡率、功能状态和神经心理功能独立相关。在一项随机试验中，对499名参与者的数据进行了二次分析，该试验比较了静脉注射硫酸镁与安慰剂治疗中度至重度TBI患者的效果。主要终点是死亡率和功能状态和神经心理功能的复合指标，评价为6个月内的记忆力、信息处理速度和执行功能。此外，作者检查了前48小时内ICP的不同总结，以检验ICP值或模式与TBI患者的死亡率和神经行为功能独立相关的假设。使用不同的先验指定测量值对ICP记录进行评价，如平均ICP，定义为前48小时ICP测量值的曲线下面积（AUC）除以对应于时间加权ICP平均值的监测时间;时间加权平均ICP [20 mmHg];基线ICP; 48小时内记录的最大ICP;以及48小时监测期结束时的最后ICP。在监测的第一个48小时内，ICP曲线（平均ICP）下的面积是主要的预测因素。总6个月死亡率为18%。与平均ICP增加10 mmHg相比，死亡率的调整比值比为3.12（95%置信区间[CI] 1.79，5.44; p\0.01）。总体而言，较高的平均ICP与功能状态和神经心理功能下降相关（p\0.01）。重要的是，在幸存者中，平均ICP的增加与神经心理测试中的表现不佳无关。本研究的结论表明，平均颅内压在入院的第一个48小时内提高不一定有不良影响的神经心理和功能能力的TBI幸存者，因为ICP和结果的关联主要是由超额死亡率。幸存者的神经心理功能和早期ICP值之间缺乏相关性，这对治疗有潜在的意义。令人鼓舞的是，观察到在ICU中具有不同ICP特征的患者在伤后6个月时可以实现相当的神经功能结局，前提是他们能够存活并达到这一里程碑。这些发现可能对TBI幸存者的临床决策和预后考虑有影响。自上个世纪末以来，神经科学家和神经重症监护医师意识到高ICP的负面影响，试图预测其上升，研究所谓的“脑顺应性”，即脑、静脉和动脉室以及CSF的顺应性的总和。因此，由此产生的整体大脑顺应性是一个非线性...
Since that moment, the cutoff point of 20 mmHg has been selected as most indicative in neurotraumatology. Not only times spent over the threshold, but also the responses to the therapy are crucial. Following this concept, Treggiari [2] systematically reviewed the literature to estimate the association between ICP patterns and outcome. Confirming Marmarou’s observations, raised ICP, ie an ICP [20 mmHg, was associated with an increased probability of death. Moreover, if ICP was raised but treatable, this condition was associated with a threefold to fourfold increase in the probability of death or poor neurological outcome. If ICP was raised and refractory, this was associated with a dramatic increase in the relative risk of death (OR 114.3). Therefore, refractory ICP and response to ICP treatment could be better predictors of neurological outcome than absolute ICP values. Badri et al.[3] examined whether raised ICP is independently associated with mortality, functional status and neuropsychological functioning in adult TBI patients. Data from 499 participants in a randomized trial, comparing intravenous magnesium sulfate to placebo in moderate to severe TBI patients, were secondarily analysed. The primary endpoints were mortality and a composite measure of functional status and neuropsychological function, evaluated as memory, speed of information processing, and executive function over a 6-month period. Moreover, the authors examined different summarizations of ICP during the first 48 h, to test the hypothesis that ICP values or patterns are independently associated with mortality and neurobehavioral function in patients with TBI. ICP recordings were evaluated using different a priori specified measures as average ICP, defined as area under the curve (AUC) of the first 48 h of ICP measurements divided by the time monitored corresponding to time-weighted ICP average; time-weighted average ICP [20 mmHg; baseline ICP; maximum ICP recorded in 48 h; and last ICP at the end of the 48 h monitoring period. The area under the curve of the ICP profile (average ICP) during the first 48 h of monitoring was the main predictor of interest. The overall 6-month mortality was 18%. The adjusted odds ratio of mortality comparing 10-mmHg increases in average ICP was 3.12 (95% confidence interval [CI] 1.79, 5.44; p\0.01). Overall, higher average ICP was associated with decreased functional status and neuropsychological functioning (p\0.01). Importantly, among survivors, increasing average ICP wasn’t independently associated with inferior performance on neuropsychological testing. The conclusions of this study suggest that raised average ICP during the first 48 h of admission does not necessarily have adverse effects on the neuropsychological and functional abilities of TBI survivors, as the association of ICP and outcome was mostly contributed by the excess mortality. The lack of association between neuropsychological function and early ICP values among survivors has potential implications for treatment. It is encouraging to observe that patients with different ICP profiles in the ICU can achieve comparable neurological outcome at 6months postinjury, provided they survive to achieve this milestone. These findings can have implications in clinical decision-making and prognostic considerations among TBI survivors.Since the final part of the last century, neuroscientist and neurointensivists, being aware of the negative effect of high ICP, tried to anticipate its rise, studying the socalled ‘brain compliance’, the sum of compliances of the brain, of the venous and arterial compartment and of CSF. Therefore, the resulting overall brain compliance is a non-linear …
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影响因子：
3.1
作者：
Feezor, RJ;Oberholzer, C;Oberholzer, A
通讯作者：
Oberholzer, A
影响因子：
38.9
作者：
Casserly, Brian;Gerlach, Herwig;Levy, Mitchell M.
通讯作者：
Levy, Mitchell M.
影响因子：
38.9
作者：
Badri, Shide;Chen, Jasper;Treggiari, Miriam M.
通讯作者：
Treggiari, Miriam M.
影响因子：
38.9
作者：
Bagshaw, Sean M.;Bennett, Michael;Bellomo, Rinaldo
通讯作者：
Bellomo, Rinaldo
影响因子：
8.8
作者：
Batchinsky, Andriy I.;Jordan, Bryan S.;Cancio, Leopoldo C.
通讯作者：
Cancio, Leopoldo C.