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The following is a summary of “Comparative Effectiveness of Intracranial Pressure Monitoring on 6-Month Outcomes of Critically Ill Patients With Traumatic Brain Injury,” published in the September 2023 issue of Neurology by Nattino et al.
A CREACTIVE study, spanning five years from March 2014, enrolled over 8,000 traumatic brain injury (TBI) patients from 83 intensive care units across seven countries. Patients meeting Brain Trauma Foundation criteria for intracranial pressure (ICP) monitoring were included in the analyses conducted between January and November 2022 to assess the short- and mid-term outcomes.
The study involved 1,448 patients from 43 ICUs. Of these, 503 patients (median age: 45 years) underwent ICP monitoring, with 392 males (77.9%) and 111 females (22.1%). Conversely, 945 patients (median age: 66 years), consisting of 656 males (69.4%) and 289 females (30.6%), were not monitored. After balancing variables, monitored patients showed worse 6-month recovery compared to nonmonitored patients: 39.2% vs. 40.6% in death/vegetative state, 33.2% vs. 25.4% in severe disability, 15.7% vs. 14.9% in moderate disability, and 11.9% vs. 19.1% in good recovery, respectively (P = .005). Monitored patients also received medical therapies more frequently.
The study findings indicated that monitoring ICP was linked to worse recovery and more frequent medical interventions with potential adverse effects. To enhance the utility of ICP monitoring for TBI) patients, additional research is necessary to explore monitoring criteria, clinical interventions, and management protocols.
Source: jamanetwork.com/journals/jamanetworkopen/fullarticle/2809949
