Abstract
Background: Severe traumatic brain injury (sTBI) is a major cause of morbidity and mortality. Intracranial pressure (ICP) monitoring and management form the cornerstone of treatment paradigms for sTBI in developed countries. We examine the available randomized controlled trial (RCT) data on the impact of ICP management on clinical outcomes after sTBI. Methods: A systematic review of the literature on ICP management following sTBI was performed to identify pertinent RCT articles. Results: We identified six RCT articles that examined whether ICP monitoring, decompressive craniectomy, or barbiturate coma improved clinical outcomes after sTBI. These studies support (1) the utility of ICP monitoring in the management of sTBI patients and (2) craniectomy and barbiturate coma as effective methods for the management of intracranial hypertension secondary to sTBI. However, despite adequate ICP control in sTBI patients, a significant proportion of surviving patients remain severely disabled. Conclusions: If one sets the bar at the level of functional independence, then the RCT data raises questions pertaining to the utility of decompressive craniectomy and barbiturate coma in the setting of sTBI.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2279-2287 |
| Number of pages | 9 |
| Journal | Acta Neurochirurgica |
| Volume | 159 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 1 2017 |
Fingerprint
Keywords
- Decompressive craniectomy
- Intracranial pressure
- Traumatic brain injury
PubMed: MeSH publication types
- Journal Article
- Review
- Systematic Review
Cite this
ICP management in patients suffering from traumatic brain injury : a systematic review of randomized controlled trials. / Abraham, Peter; Rennert, Robert C.; Gabel, Brandon C.; Sack, Jayson A.; Karanjia, Navaz; Warnke, Peter; Chen, Clark C.
In: Acta Neurochirurgica, Vol. 159, No. 12, 01.12.2017, p. 2279-2287.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - ICP management in patients suffering from traumatic brain injury
T2 - a systematic review of randomized controlled trials
AU - Abraham, Peter
AU - Rennert, Robert C.
AU - Gabel, Brandon C.
AU - Sack, Jayson A.
AU - Karanjia, Navaz
AU - Warnke, Peter
AU - Chen, Clark C
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Background: Severe traumatic brain injury (sTBI) is a major cause of morbidity and mortality. Intracranial pressure (ICP) monitoring and management form the cornerstone of treatment paradigms for sTBI in developed countries. We examine the available randomized controlled trial (RCT) data on the impact of ICP management on clinical outcomes after sTBI. Methods: A systematic review of the literature on ICP management following sTBI was performed to identify pertinent RCT articles. Results: We identified six RCT articles that examined whether ICP monitoring, decompressive craniectomy, or barbiturate coma improved clinical outcomes after sTBI. These studies support (1) the utility of ICP monitoring in the management of sTBI patients and (2) craniectomy and barbiturate coma as effective methods for the management of intracranial hypertension secondary to sTBI. However, despite adequate ICP control in sTBI patients, a significant proportion of surviving patients remain severely disabled. Conclusions: If one sets the bar at the level of functional independence, then the RCT data raises questions pertaining to the utility of decompressive craniectomy and barbiturate coma in the setting of sTBI.
AB - Background: Severe traumatic brain injury (sTBI) is a major cause of morbidity and mortality. Intracranial pressure (ICP) monitoring and management form the cornerstone of treatment paradigms for sTBI in developed countries. We examine the available randomized controlled trial (RCT) data on the impact of ICP management on clinical outcomes after sTBI. Methods: A systematic review of the literature on ICP management following sTBI was performed to identify pertinent RCT articles. Results: We identified six RCT articles that examined whether ICP monitoring, decompressive craniectomy, or barbiturate coma improved clinical outcomes after sTBI. These studies support (1) the utility of ICP monitoring in the management of sTBI patients and (2) craniectomy and barbiturate coma as effective methods for the management of intracranial hypertension secondary to sTBI. However, despite adequate ICP control in sTBI patients, a significant proportion of surviving patients remain severely disabled. Conclusions: If one sets the bar at the level of functional independence, then the RCT data raises questions pertaining to the utility of decompressive craniectomy and barbiturate coma in the setting of sTBI.
KW - Decompressive craniectomy
KW - Intracranial pressure
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85031900962&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85031900962&partnerID=8YFLogxK
U2 - 10.1007/s00701-017-3363-1
DO - 10.1007/s00701-017-3363-1
M3 - Review article
VL - 159
SP - 2279
EP - 2287
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
IS - 12
ER -