Division of Neurocritical Care, Department of Neurology, Baylor College of Medicine, Houston, TX.
Division of Biostatistics, School of Public Health, University of Texas, Houston, TX.
J Crit Care. 2015 Dec;30(6):1258-62. doi: 10.1016/j.jcrc.2015.08.003. Epub 2015 Aug 5.
The aim of this study was to explore the relationship of intracranial pressure (ICP) with intensive care unit (ICU) length of stay in a large cohort of severe traumatic brain injury patients and identify factors associating with prolonged ICU course.
This was a single-center database review of de-identified research data that had been prospectively collected; setting: neurosurgical ICU, Ben Taub General Hospital, Houston, TX.
In a cohort of 438 severe traumatic brain injury (TBI) patients, 149 (34%) had a motor Glasgow Coma Scale score of 1 to 3 on admission and 284 (65%) had 4 to 5. Intracranial pressure during the ICU course was 19.8±11.2 mm Hg. Favorable outcome was obtained in 148 (34%), and unfavorable, in 211 (48%) patients with a mortality of 28%. ICU length of stay (LOS) was 19.4±13.9 days. Joint modeling of ICP and ICU LOS was undertaken, adjusted for the International Mission for Prognosis and Analysis of Clinical Trials in TBI admission prognostic indicators. A higher ICP was not significantly associated with longer ICU LOS (P=.4). However, presence of a mass lesion on admission head computed tomography was strongly correlated with a prolonged ICU LOS (P=.0007). Diffuse injuries with basal cistern compression or midline shift were marginally associated with a longer ICU LOS (P=.053).
ICP, as monitored and managed according to BTF guidelines, is not associated with ICU length of stay. Patients with severe TBI and a mass lesion on admission head computed tomography were found to have prolonged ICU LOS independently of other indicators of injury severity and intracranial pressure course.
本研究旨在探讨大样本严重创伤性脑损伤患者颅内压（ICP）与重症监护病房（ICU）住院时间的关系，并确定与 ICU 住院时间延长相关的因素。
这是一项对经过前瞻性收集的去识别研究数据的单中心数据库回顾；地点：德克萨斯州休斯顿 Ben Taub 综合医院神经外科 ICU。
在 438 例严重创伤性脑损伤（TBI）患者中，149 例（34%）入院时格拉斯哥昏迷评分（GCS）运动评分为 1 至 3 分，284 例（65%）为 4 至 5 分。ICU 期间的 ICP 为 19.8±11.2mmHg。148 例（34%）获得良好结局，211 例（48%）结局不良，死亡率为 28%。ICU 住院时间（LOS）为 19.4±13.9 天。对 ICP 和 ICU LOS 进行联合建模，调整了国际创伤预后与分析临床试验的 TBI 入院预后指标。较高的 ICP 与较长的 ICU LOS 无显著相关性（P=.4）。然而，入院头部 CT 上存在肿块与 ICU LOS 延长有很强的相关性（P=.0007）。弥漫性损伤伴基底池受压或中线移位与 ICU LOS 延长有一定的相关性（P=.053）。
根据 BTF 指南监测和管理的 ICP 与 ICU 住院时间无关。入院头部 CT 上存在肿块的严重 TBI 患者，其 ICU 住院时间延长，与其他损伤严重程度和 ICP 病程指标无关。
