The Role of Intracranial Pressure (ICP) Monitoring in Severe Traumatic Brain Injury (TBI)
Keywords:
Glasgow coma scale, Glasgow outcome scale,, Intra cranial pressure, Traumatic Brain Injury.Abstract
The management of patients with severe head injury is a prodigious task for any neurosurgical team. After the initial life support, the management plan of patient with traumatic brain injury rest on the findings of a cranial CT scan. The treatment options of TBI differ with severity of trauma. Osmotic diuretics in the acute phase can be helpful. Hyperventilation is a method to be used in conjunction with other options in certain situations. Normal values of intra cranial pressure (ICP) vary with age, being 10 to 15 mm Hg in an adult. Intra cranial pressure (ICP) values of 20 to 30 mm Hg shows mild intracranial hypertension, while sustained intra cranial pressure (ICP) values more than 40 mm Hg indicate life threatening malignant intracranial hypertension which should be lowered immediately. Measuring the intra cranial pressure of severe traumatic brain injury patients is now mandatory as it allows an effective and control way of lowering the raised ICP with very good outcome results.
Objective: To adjust the ICP lowering mechanics according to the reading obtained via the ICP monitor in patients after severe head injury so as to minimize the need of ventilatory support and decrease the patients’ stay at hospital.
1. To measure the value of ICP by using ICP monitoring in severe head injuries (GCS score below or equal to 8).
2. To assess the outcome of the conservative measures in patients in whom ICP was monitored, on the basis of Glasgow Outcome Scale.
Study Design: Prospective descriptive study.
Setting: Department of Neurosurgery, Lahore General Hospital, Lahore.
Duration of Study: One year from July 2012 to July 2013.
Material and Methods: Thirty patients of traumatic brain injury were included in this study. ICP monitoring was done via Integra intra parenchymal Camino bolt and Integra ICP monitors.
Results: Out of 30 patients, there were 21 (70%) male patients and 9 (30%) female patients.The male to female ratio was 2.33:1. In 20 (67%) patients the ICP ranged from 25-34 mmHg. There were 10 (33%) patients having ICP of 35 – 50 mm Hg. The mean intracranial pressure was 29.5 ± 6.96. The Glasgow coma scale of our patients was such that there were2 (6.6%) patients had GCS 5. In GCS 6 there were 20 (66%) patients. There were 3 (10%) patients who had a GCS of 7. In GCS 8 there were 5 (16.6) patients. The ventilation duration was 5 – 15 days. The frequency of hospital stay in our patients 10-30 days. There were 2 (7%) patients of Glasgow outcome scale of grade – I. In grade – II, there were 3 (10%) patients, no patient in Glasgow outcome scale grade – III. There were 10 (33%) patients in grade – IV while 15 (50%) patient were in grade – V. In the follow up cases, after 1 month, there were no patient in grade – I. There were 3 (10%) patients of GOS grade – II, in grade – III there were 4 (13%) patients, there were 8 (27%) patients grade – IV. 15 (50%) patients of grade – V. After 3 month, there was 1 (3%) patient in grade – I. There were 2 (7%) patients of GOS grade – II, in grade – III there were 2 (7%) patients, there were 10 (33%) patients grade – IV. 15 (50%) patients of grade – V.
Conclusion: It is concluded that ICP monitoring is useful for improving the outcome of traumatic brain injury patients. Most of the patients were in young age. Majority of the patients had a low Glasgow coma scales. In our study most of the patients were male. In this study there is short duration of ventilation in patients and a short hospital stay in patients of TBI in which ICP is monitored and addressed promptly.
References
severe head injury with early diagnosis and intensive
management. J Neurosurg. 1977; 47: 491-502.
2. Eisenber HM, Gary HE Jr, Aldrich EF. Initial CT findings
in 753 patients with severe closed injury. A report
from the NIH Traumatic coma data bank. J Neurosurg.
1990; 73: 688-98.
3. Giuseppe Citerio, Peter J D Andrews. Intracranial pressure:
Part two: Clinical applications and technology. Intensive
Care Med 2004; 30: 1882-5.
4. Isa R, Wan Adnan WA, Ghazali G, et al. Outcome of
severe traumatic brain injury: comparison of three monitoring
approaches. Neurosurg Focus, 2003.
5. Jane JA, Luerssen Tg, Marmarou A, Foulkes MA. The
outcome of severe closed head injury. J Neurosurg.
1991; 75 (suppl): 528-36.
6. Jennett B, Teasdale G, Galbraith S. Severe head injury
in three countries. J Neurol Neurosurg Psychiatr. 1977;
40: 291-5.
7. Johnston IH, Johnston JA, Jennett WB. Intracranial pressure
following head injury. Lancet, 1970; 2: 433-6.
8. Kostas N Fountas, ArturasSitkauskas, Carlos H Feltes.
Is non-invasive monitoring of intracranial pressure
wave form analysis possible? Preliminary results of a
comparative study of non-invasive vs. invasive intracranial
slow wave waveform analysis monitoring in patients
with traumatic brain injury. Med Sci Monit 2005;
112: CR 58-63.
9. Lundberg N. Continous recording and control of ventricular
fluid pressure in neurosurgical practice. Acta
Psychiatr Neurol Scand (suppl), 1960; 36: 1-193.
10. Mahapatra AK, Bansal S. Role of intracranial pressure
monitoring in head injury. A prospective study. Neurology
India, 1998; 46: 109-16.
11. Marmarou A, Anderson RL, Ward JD. Impact of ICP instability and hypotension on outcome in patients with severe head injury. J Neurosurg. 1991; 75: 559-66.
12. Marshall LF, Gautille T, Klauber MR. The outcome of severe closed head injury. J Neurosurg. 1991; 75: 528-36.
13. Marshall LF, Smith RW, Shapiro HM. The outcome with aggressive treatment in severe head injury. Part I. The significance of intracranial pressure monitoring. J Neurosurg. 1979; 80: 20-25.
14. Miller JD. ICP monitoring – current status and future direction. Acta Neurochir. 1987; 85: 80-6.
15. Miller JD, Butterworth JF, Gudeman SK. Further expe-rience in management of severe head injury. J Neuro-surg. 1981; 54: 289-99.
16. Miller JD, Becker CD, Ward JD. Significance of intra-cranial hypertension in severe head injury. J Neurosurg. 1977; 47: 563-76.
17. Narayan RK, Kishore PR, Becker DP. Intracranial pres-sure to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg. 1982; 56: 650-9.
18. Ostrup RC, Luerssen TG, Marshall LF, Zornow MH. Continous monitoring of intracranial pressure with a miniaturized fibreoptic device. J Neurosurg. 1987; 67: 206-9.
19. Saul TG, Ducker TB. Effects of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg. 1982; 56: 498-503.
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