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dc.contributor.authorNourallah, Basilen
dc.contributor.authorZeiler, Fredericken
dc.contributor.authorCalviello, Leanneen
dc.contributor.authorSmielewski, Peteren
dc.contributor.authorCzosnyka, Mareken
dc.contributor.authorMenon, Daviden
dc.date.accessioned2018-07-20T12:37:19Z
dc.date.available2018-07-20T12:37:19Z
dc.date.issued2018-07en
dc.identifier.issn0001-6268
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/278342
dc.description.abstractBackground: Intracranial pressure (ICP)- and cerebral perfusion pressure (CPP)- guided therapy is central to neurocritical care for traumatic brain injury (TBI) patients. We sought to identify time-dependent critical thresholds for mortality and unfavourable outcome for ICP and CPP in non-craniectomized TBI patients. Methods: This is a retrospective cohort study of 355 patients with moderate-to-severe TBI who received ICP monitoring and were managed without decompressive craniectomy in a tertiary hospital neurocritical care unit. Patients were grouped in 2x2 tables according to survival/death or favourable/unfavourable outcomes at 6 months, and serial thresholds of mean ICP and CPP, using increments of 0.1 and 0.5 mmHg respectively. Sequential chi-square analysis was performed and the thresholds yielding the highest chi-square test statistic were taken as having the best discriminative value for outcome. This process was repeated over monitoring periods of 1, 3, 5 and 7 days, and for each day of recording to establish time-dependent thresholds. The same analysis was performed for age and sex subgroups. Results: Global ICP thresholds were 21.3 mmHg and 20.5 mmHg for mortality and unfavourable outcome respectively (p<0.001). After the first day of ICP monitoring, ICP thresholds fell to between 15 – 20 mmHg and remained significant (p<0.05). Significant time-dependent CPP thresholds for mortality or unfavourable outcome were often not identified and no identifiable trends were produced. Conclusion: Critical ICP thresholds in non-craniectomized TBI patients vary with time and fall below established ICP targets after the first day of monitoring.
dc.format.mediumPrint-Electronicen
dc.languageengen
dc.publisherSpringer Nature
dc.rightsAttribution 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectHumansen
dc.subjectRetrospective Studiesen
dc.subjectCerebrovascular Circulationen
dc.subjectIntracranial Pressureen
dc.subjectAdolescenten
dc.subjectAdulten
dc.subjectMiddle Ageden
dc.subjectFemaleen
dc.subjectMaleen
dc.subjectDecompressive Craniectomyen
dc.subjectBrain Injuries, Traumaticen
dc.titleCritical thresholds for intracranial pressure vary over time in non-craniectomised traumatic brain injury patients.en
dc.typeArticle
prism.endingPage1324
prism.issueIdentifier7en
prism.publicationDate2018en
prism.publicationNameActa neurochirurgicaen
prism.startingPage1315
prism.volume160en
dc.identifier.doi10.17863/CAM.25689
dcterms.dateAccepted2018-04-18en
rioxxterms.versionofrecord10.1007/s00701-018-3555-3en
rioxxterms.versionVoR*
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2018-07en
dc.contributor.orcidZeiler, Frederick [0000-0003-1737-0510]
dc.contributor.orcidCalviello, Leanne [0000-0001-5012-2725]
dc.contributor.orcidSmielewski, Peter [0000-0001-5096-3938]
dc.contributor.orcidCzosnyka, Marek [0000-0003-2446-8006]
dc.contributor.orcidMenon, David [0000-0002-3228-9692]
dc.identifier.eissn0942-0940
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idEC FP7 CP (602150)
cam.orpheus.successThu Jan 30 12:59:15 GMT 2020 - The item has an open VoR version.*
rioxxterms.freetoread.startdate2100-01-01


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International