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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (SYNAPSE-ICU): an international, prospective observational cohort study
The Lancet Neurology, Volume 20, No. 7, Year 2021
Notification
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Description
Background: The indications for intracranial pressure (ICP) monitoring in patients with acute brain injury and the effects of ICP on patients’ outcomes are uncertain. The aims of this study were to describe current ICP monitoring practises for patients with acute brain injury at centres around the world and to assess variations in indications for ICP monitoring and interventions, and their association with long-term patient outcomes. Methods: We did a prospective, observational cohort study at 146 intensive care units (ICUs) in 42 countries. We assessed for eligibility all patients aged 18 years or older who were admitted to the ICU with either acute brain injury due to primary haemorrhagic stroke (including intracranial haemorrhage or subarachnoid haemorrhage) or traumatic brain injury. We included patients with altered levels of consciousness at ICU admission or within the first 48 h after the brain injury, as defined by the Glasgow Coma Scale (GCS) eye response score of 1 (no eye opening) and a GCS motor response score of at least 5 (not obeying commands). Patients not admitted to the ICU or with other forms of acute brain injury were excluded from the study. Between-centre differences in use of ICP monitoring were quantified by using the median odds ratio (MOR). We used the therapy intensity level (TIL) to quantify practice variations in ICP interventions. Primary endpoints were 6 month mortality and 6 month Glasgow Outcome Scale Extended (GOSE) score. A propensity score method with inverse probability of treatment weighting was used to estimate the association between use of ICP monitoring and these 6 month outcomes, independently of measured baseline covariates. This study is registered with ClinicalTrial.gov, NCT03257904. Findings: Between March 15, 2018, and April 30, 2019, 4776 patients were assessed for eligibility and 2395 patients were included in the study, including 1287 (54%) with traumatic brain injury, 587 (25%) with intracranial haemorrhage, and 521 (22%) with subarachnoid haemorrhage. The median age of patients was 55 years (IQR 39–69) and 1567 (65%) patients were male. Considerable variability was recorded in the use of ICP monitoring across centres (MOR 4·5, 95% CI 3·8–4·9 between two randomly selected centres for patients with similar covariates). 6 month mortality was lower in patients who had ICP monitoring (441/1318 [34%]) than in those who were not monitored (517/1049 [49%]; p<0·0001). ICP monitoring was associated with significantly lower 6 month mortality in patients with at least one unreactive pupil (hazard ratio [HR] 0·35, 95% CI 0·26–0·47; p<0·0001), and better neurological outcome at 6 months (odds ratio 0·38, 95% CI 0·26–0·56; p=0·0025). Median TIL was higher in patients with ICP monitoring (9 [IQR 7–12]) than in those who were not monitored (5 [3–8]; p<0·0001) and an increment of one point in TIL was associated with a reduction in mortality (HR 0·94, 95% CI 0·91–0·98; p=0·0011). Interpretation: The use of ICP monitoring and ICP management varies greatly across centres and countries. The use of ICP monitoring might be associated with a more intensive therapeutic approach and with lower 6-month mortality in more severe cases. Intracranial hypertension treatment guided by monitoring might be considered in severe cases due to the potential associated improvement in long-term clinical results. Funding: University of Milano-Bicocca and the European Society of Intensive Care Medicine. © 2021 Elsevier Ltd
Authors & Co-Authors
Robba, Chiara
Italy, Genoa
Irccs San Martino Polyclinic Hospital
Italy, Genoa
Università Degli Studi Di Genova
Oddo, Mauro
Switzerland, Lausanne
Centre Hospitalier Universitaire Vaudois
Meyfroidt, Geert
Belgium, Leuven
Ku Leuven– University Hospital Leuven
Helbok, Raimund
Austria, Innsbruck
Medizinische Universitat Innsbruck
Taccone, Fabio Silvio S.
Belgium, Brussels
Université Libre de Bruxelles
Vincent, Jean Louis
Belgium, Brussels
Université Libre de Bruxelles
Suárez, José Ignacio
United States, Baltimore
Johns Hopkins School of Medicine
Stocchetti, Nino
Italy, Milan
Università Degli Studi Di Milano
Italy, Milan
Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico
Citerio, Giuseppe
Italy, Milan
Università Degli Studi Di Milano-bicocca
Italy, Monza
Azienda Ospedaliera San Gerardo Monza
Abdelaty, Mohamed Adel
Unknown Affiliation
Arabi, Yaseen M.
Unknown Affiliation
Aragão, Irene César
Unknown Affiliation
Asehnoune, Karim
Unknown Affiliation
Badenes, R.
Unknown Affiliation
Besch, Guillaume
Unknown Affiliation
Biston, Patrick
Unknown Affiliation
Caillard, Anaïs
Unknown Affiliation
Cinotti, Raphaël
Unknown Affiliation
Cortegiani, Andrea
Unknown Affiliation
Dibu, Jamil R.
Unknown Affiliation
Elhadi, Muhammed K.
Unknown Affiliation
Fuest, Kristina E.
Unknown Affiliation
Galarza, Laura
Unknown Affiliation
Gempeler, A.
Unknown Affiliation
Gritsan, Alexey I.
Unknown Affiliation
Gupta, Deepak Kumar
Unknown Affiliation
Idowu, O. E.
Unknown Affiliation
Jibaja, Manuel
Unknown Affiliation
Kilapong, Bram
Unknown Affiliation
Kolias, Angelos Georgiou
Unknown Affiliation
Lamperti, Massimo
Unknown Affiliation
Lavička, Pavel
Unknown Affiliation
Lindner, Anna
Unknown Affiliation
Mejia-Mantilla, Jorge Humberto
Unknown Affiliation
Monleón, Berta
Unknown Affiliation
Mouloudi, Eleni K.
Unknown Affiliation
Muehlschlegel, Susanne
Unknown Affiliation
Ñamendys-Silva, Silvio A.
Unknown Affiliation
Olson, Daiwai M.
Unknown Affiliation
Ozair, Ahmad
Unknown Affiliation
Picetti, Edoardo
Unknown Affiliation
Reade, Michael C.
Unknown Affiliation
Schaller, Stefan J.
Unknown Affiliation
Sellami, Walid
Unknown Affiliation
Seppelt, Ian
Unknown Affiliation
Serrano, A.
Unknown Affiliation
Shrestha, Gentle Sunder
Unknown Affiliation
Sivakumar, Sanjeev
Unknown Affiliation
Soyer, Benjamin
Unknown Affiliation
Olson, Zachary D.
Unknown Affiliation
Videtta, Walter
Unknown Affiliation
Wolf, Stefan
Unknown Affiliation
Statistics
Citations: 82
Authors: 52
Affiliations: 12
Identifiers
Doi:
10.1016/S1474-4422(21)00138-1
ISSN:
14744422
Research Areas
Environmental
Health System And Policy
Noncommunicable Diseases
Violence And Injury
Study Design
Cohort Study
Case-Control Study
Study Approach
Quantitative
Participants Gender
Male