Comparative Effectiveness of Intracranial Pressure Monitoring on 6-Month Outcomes of Critically Ill Patients With Traumatic Brain Injury

被引:19
作者
Nattino, Giovanni [1 ]
Gamberini, Lorenzo [2 ]
Brissy, Obou [1 ]
Carrara, Greta [1 ]
Chesnut, Randall [3 ,4 ]
Chiarini, Valentina [2 ]
Chieregato, Arturo [5 ]
Csomos, Akos [6 ]
Fleming, Joanne M. [1 ]
Gradisek, Primoz [7 ,8 ]
Kaps, Rafael [9 ]
Kyprianou, Theodoros [10 ,11 ]
Lazar, Isaac [12 ,13 ]
Lemeshow, Stanley [14 ]
Mikaszewska-Sokolewicz, Malgorzata [15 ]
Paci, Giulia [16 ]
Rossi, Carlotta [1 ,20 ]
Temkin, Nancy [17 ,18 ]
Xirouchaki, Nektaria [19 ]
Giugni, Aimone [2 ]
Bertolini, Guido [1 ]
CREACTIVE Consortium
机构
[1] Ist Ric Farmacolog Mario Negri IRCCS, Dept Publ Hlth, Lab Clin Epidemiol, Ranica, Bergamo, Italy
[2] Maggiore Hosp, Anesthesia Intens Care & Prehosp Emergency, Bologna, Italy
[3] Univ Washington, Dept Neurol Surg, Seattle, WA USA
[4] Univ Washington, Sch Global Hlth, Seattle, WA USA
[5] Grande Osped Metropolitano Niguarda, Neurointens Care Unit, Milan, Italy
[6] Hungarian Army Med Ctr, Budapest, Hungary
[7] Univ Med Ctr Ljubljana, Clin Dept Anaesthesiol & Intens Therapy, Ljubljana, Slovenia
[8] Univ Ljubljana, Fac Med, Ljubljana, Slovenia
[9] Gen Hosp Novo Mesto, Novo Mesto, Slovenia
[10] Univ Nicosia, Med Sch, Nicosia, Cyprus
[11] Univ Hosp Bristol & Weston NHS Fdn Trust, Bristol, England
[12] Bengurion Univ Negev, Soroka Med Ctr, Pediat Intens Care Unit, Beer Sheva, Israel
[13] Bengurion Univ Negev, Fac Hlth Sci, Beer Sheva, Israel
[14] Ohio State Univ, Coll Publ Hlth, Div Biostat, Columbus, OH USA
[15] Med Univ Warsaw, Clin Anaesthes & Intens Care, Warsaw, Poland
[16] Maurizio Bufalini Hosp, Hosp Nursing Management, AUSL Romagna, Cesena, Italy
[17] Univ Washington, Dept Neurol Surg, Seattle, WA USA
[18] Univ Washington, Dept Biostat, Seattle, WA USA
[19] Univ Hosp Heraklion, Iraklion, Greece
[20] Ist Ric Farmacolog Mario Negri IRCCS, Dept Publ Hlth, Lab Clin Epidemiol, Villa Camozzi,Via GB Camozzi 3, I-24020 Ranica, Italy
关键词
PROPENSITY SCORE; IMPACT; GUIDELINES; MANAGEMENT; MORTALITY;
D O I
10.1001/jamanetworkopen.2023.34214
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Importance While the relationship between persistent elevations in intracranial pressure (ICP) and poorer outcomes is well established for patients with traumatic brain injury (TBI), there is no consensus on how ICP measurements should drive treatment choices, and the effectiveness of ICP monitoring remains unknown.ObjectiveTo evaluate the effectiveness of ICP monitoring on short- and mid-term outcomes of patients with TBI.Design, Setting, and Participants CREACTIVE was a prospective cohort study that started in March 2014 and lasted 5 years. More than 8000 patients with TBI were enrolled at 83 intensive care units (ICUs) from 7 countries who joined the CREACTIVE Consortium. Patients with TBI who met the Brain Trauma Foundation guidelines for ICP monitoring were selected for the current analyses, which were performed from January to November 2022.Exposure Patients who underwent ICP monitoring within 2 days of injury (exposure group) were propensity score-matched to patients who were not monitored or who underwent monitoring 2 days after the injury (control group).Main Outcome and Measure Functional disability at 6 months as indicated by Glasgow Outcome Scale-Extended (GOS-E) score.Results A total of 1448 patients from 43 ICUs in Italy and Hungary were eligible for analysis. Of the patients satisfying the ICP-monitoring guidelines, 503 (34.7%) underwent ICP monitoring (median [IQR] age: 45 years [29-61 years]; 392 males [77.9%], 111 females [22.1%]) and 945 were not monitored (median [IQR] age: 66 years [48-78 years]; 656 males [69.4%], 289 females [30.6%]). After matching to balance the variables, worse 6-month recovery was observed for monitored patients compared with nonmonitored patients (death/vegetative state: 39.2% vs 40.6%; severe disability: 33.2% vs 25.4%; moderate disability: 15.7% vs 14.9%; good recovery: 11.9% vs 19.1%, respectively; P = .005). Monitored patients received medical therapies significantly more frequently.Conclusions and Relevance In this cohort study, ICP monitoring was associated with poorer recovery and more frequent medical interventions with their relevant adverse effects. Optimizing the value of ICP monitoring for TBI requires further investigation on monitoring indications, clinical interventions, and management protocols.
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页数:14
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