Brain Injury Center, Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Institute of Head Trauma, Shanghai, China.
Neurocrit Care. 2022 Aug;37(1):160-171. doi: 10.1007/s12028-022-01463-w. Epub 2022 Mar 4.
Although the current guidelines recommend the use of intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (sTBI), the evidence indicating benefit is limited. The present study aims to evaluate the impact of ICP monitoring on patients with sTBI in the intensive care unit (ICU).
The patient data were obtained from the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury China Registry, a prospective, multicenter, longitudinal, observational, cohort study. Patients with sTBI who were admitted to 52 ICUs across China, managed with ICP monitoring or without, were analyzed in this study. Patients with missing information on discharge survival status, Glasgow Coma Scale score on admission to hospital, and record of ICP monitoring application were excluded from the analysis. Data on demographic characteristics, injury, clinical features, treatments, survival at discharge, discharge destination, and length of stay were collected and assessed. The primary end point was survival state at discharge, and death from any cause was considered the event of interest.
A total of 2029 patients with sTBI were admitted to the ICU; 737 patients (36.32%) underwent ICP monitoring, and 1292 (63.68%) were managed without ICP monitoring. There was a difference between management with and without ICP monitoring on in-hospital mortality in the unmatched cohort (18.86% vs. 26.63%, p < 0.001) and the propensity-score-matched cohort (19.82% vs. 26.83%, p = 0.003). Multivariate logistic regressions also indicated that increasing age, higher injury severity score, lower Glasgow Coma Scale score, unilateral and bilateral pupillary abnormalities, systemic hypotension (SBP ≤ 90 mm Hg), hypoxia (SpO2 < 95%) on arrival at the hospital, and management without ICP monitoring were associated with higher in-hospital mortality. However, the patients without ICP monitoring had a lower length of stay in the ICU (11.79 vs. 7.95 days, p < 0.001) and hospital (25.96 vs. 21.71 days, p < 0.001), and a higher proportion of survivors were discharged to the home with better recovery in self-care.
Although ICP monitoring was not widely used by all of the centers participating in this study, patients with sTBI managed with ICP monitoring show a better outcome in overall survival. Nevertheless, the use of ICP monitoring makes the management of sTBI more complex and increases the costs of medical care by prolonging the patient's stay in the ICU or hospital.
尽管目前的指南建议在严重创伤性脑损伤（sTBI）患者中使用颅内压（ICP）监测，但表明其有益的证据有限。本研究旨在评估 ICP 监测对重症监护病房（ICU）中 sTBI 患者的影响。
患者数据来自中国颅脑创伤协作研究组前瞻性、多中心、纵向、观察性队列研究。本研究分析了在中国 52 家 ICU 接受 ICP 监测或未接受 ICP 监测的 sTBI 患者。排除了出院生存状态、入院时格拉斯哥昏迷量表评分和 ICP 监测应用记录缺失的患者。收集并评估了人口统计学特征、损伤、临床特征、治疗、出院时生存、出院去向和住院时间的数据。主要终点是出院时的生存状态，任何原因导致的死亡均视为感兴趣事件。
共有 2029 例 sTBI 患者入住 ICU；737 例（36.32%）接受了 ICP 监测，1292 例（63.68%）未接受 ICP 监测。未匹配队列中，ICP 监测组与未监测组院内死亡率存在差异（18.86%比 26.63%，p<0.001）和倾向评分匹配队列中（19.82%比 26.83%，p=0.003）。多变量逻辑回归也表明，年龄较大、损伤严重程度评分较高、格拉斯哥昏迷量表评分较低、单侧和双侧瞳孔异常、全身性低血压（SBP≤90mmHg）、入院时缺氧（SpO2<95%）和未行 ICP 监测与较高的院内死亡率相关。然而，未行 ICP 监测的患者 ICU 住院时间（11.79 比 7.95 天，p<0.001）和医院住院时间（25.96 比 21.71 天，p<0.001）更短，且有更多的幸存者出院回家并在自我护理方面得到更好的恢复。
尽管本研究参与的所有中心并未广泛使用 ICP 监测，但接受 ICP 监测管理的 sTBI 患者的总体生存结局更好。然而，ICP 监测的使用使 sTBI 的管理更加复杂，并通过延长患者在 ICU 或医院的住院时间增加医疗费用。
