ArticleIntensive care medicine2008
Refractory intracranial hypertension and "second-tier" therapies in traumatic brain injury.
Article in Intensive care medicine, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 1 of them a synthesis that pooled it.
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Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it, 127 citations in OpenAlex.
- Basal cisternostomy as an adjunct to decompressive hemicraniectomy in moderate to severe traumatic brain injury: a systematic review and meta-analysis.Neurosurgical review · 2024Pooled it
- Patient Outcomes at Twelve Months after Early Decompressive Craniectomy for Diffuse Traumatic Brain Injury in the Randomized DECRA Clinical Trial.Journal of neurotrauma · 2020Trial
- Lower body negative pressure to safely reduce intracranial pressure.The Journal of physiology · 2019Trial
- Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial.Neurocritical care · 2016Trial
- Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial.Critical care (London, England) · 2008Trial
- Characteristics and recovery trends of severe TBI patients with a favorable functional outcome at 6-month follow-up.Neurosurgical review · 2025Article
- Characteristics and outcome of patients requiring Decompressive Craniectomy for Traumatic Brain Injury: a retrospective analysis.Neurosurgical review · 2024Article
- Intracranial pressure changes in traumatic brain injury patients undergoing unilateral decompressive craniectomy with dural expansion.World neurosurgery: X · 2024Article
- Clinical Management in Traumatic Brain Injury.Biomedicines · 2024Review
- Management Strategies Based on Multi-Modality Neuromonitoring in Severe Traumatic Brain Injury.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2023Review
- Comparative Effectiveness of Intracranial Pressure Monitoring vs No Monitoring in Severe Penetrating Brain Injury Management.JAMA network open · 2023Article
- Escalation therapy in severe traumatic brain injury: how long is intracranial pressure monitoring necessary?Neurosurgical review · 2021Review
- A Retrospective Analysis of Intracranial Pressure Monitoring and Outcomes in Adults after Severe Traumatic Brain Injury at Kaiser Permanente Trauma Centers.The Permanente journal · 2021Article
- Novel Synthetic and Natural Therapies for Traumatic Brain Injury.Current neuropharmacology · 2021Review
- An overview of management of intracranial hypertension in the intensive care unit.Journal of anesthesia · 2020Review
- Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury.Journal of clinical medicine · 2020Article
- Cerebral Edema in Traumatic Brain Injury: a Historical Framework for Current Therapy.Current treatment options in neurology · 2020Article
- Role of Sulfonylurea Receptor 1 and Glibenclamide in Traumatic Brain Injury: A Review of the Evidence.International journal of molecular sciences · 2020Review
- Deciding Under Uncertainty: The Case of Refractory Intracranial Hypertension.Frontiers in neurology · 2020Article
- Escalate and De-Escalate Therapies for Intracranial Pressure Control in Traumatic Brain Injury.Frontiers in neurology · 2020Review
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo quantify the occurrence of high intracranial pressure (HICP) refractory to conventional medical therapy after traumatic brain injury (TBI) and to describe the use of more aggressive therapies (profound hyperventilation, barbiturates, decompressive craniectomy).
designProspective study of 407 consecutive TBI patients
settingThree neurosurgical intensive care units (ICU). MEASUREMENTS AND
resultsIntracranial pressure (ICP) was studied during the first week after TBI; 153 patients had at least 1 day of ICP>20 mmHg. Early surgery was necessary for 221 cases, and standard medical therapy [sedation, mannitol, cerebrospinal fluid (CSF) withdrawal, PaCO2 30-35 mmHg] was used in 135 patients. Reinforced treatment (PaCO2 25-29 mmHg, induced arterial hypertension, muscle relaxants) was used in 179 cases (44%), and second-tier therapies in 80 (20%). Surgical decompression and/or barbiturates were used in 28 of 407 cases (7%). Six-month outcome was recorded in 367 cases using the Glasgow outcome scale (GOS). The outcome was favorable (good recovery or moderate disability) in 195 cases (53%) and unfavorable (all the other categories) in 172 (47%). HICP was associated with worse outcome. Outcome for cases who had received second-tier therapies was significantly worse (43% favorable at 6 months, p=0.03).
conclusionsHICP is frequent and is associated with worse outcome. ICP was controlled by early surgery and first-tier therapies in the majority of cases. Profound hyperventilation, surgical decompression and barbiturates were used in various combinations in a minority of cases. The indications for surgical decompression and/or barbiturates seem restricted to less than 10% of severe TBI.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.