Citation

Donnelly J, Güiza F, Depreitere B, Meyfroidt G, Czosnyka M, Smielewski P. Br. J. Anaesth. 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, Oxford University Press)

DOI

10.1016/j.bja.2020.09.018

PMID

33183738

Abstract

Editor--Elevated intracranial pressure (ICP) after severe traumatic brain injury (TBI) is an important cause of secondary brain injury, either by hypoperfusion because of decreased cerebral perfusion pressure (CPP), or by mechanical distortion leading to brain herniation. The thresholds to treat elevated ICP in severe TBI (20 or 22 mm Hg) are based on epidemiological studies, however, early application of aggressive measures to treat brief episodes of ICP elevations above 20 mm Hg have shown harm. Moreover, the association between elevated ICP and outcome is not merely attributable to crossing a threshold, but depends upon the magnitude and the duration of intracranial hypertension. This has been demonstrated in a multicentre prospective European dataset ( n=261) by Güiza and colleagues. Using a three-dimensional visualisation technique, they showed that worse outcomes (taken at 6 months) could be explained by the interaction between the level of ICP elevation and the duration of the hypertensive episode, confirming a clinically intuitive concept. For instance, insults of high ICP, >30 mm Hg, seemed to be only tolerated for a short time (<8 min), whereas ICP>20 mm Hg leads, on average, to a poor outcome if sustained over 37 min. The ability to tolerate elevated ICP was decreased in children, when cerebrovascular autoregulation was absent, and when CPP was inadequate. To date, this visualisation technique has not been replicated outside of the prospective European dataset...

Language: en

Keywords

traumatic brain injury; cerebral autoregulation; data visualisation; intracranial monitoring; intracranial pressure; secondary insults