ArticlePloS one2020
Impact of duration and magnitude of raised intracranial pressure on outcome after severe traumatic brain injury: A CENTER-TBI high-resolution group study.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06429657 (Ketamine for Sedation in Severe Traumatic Brain Injury), which is not on this map. Cited by 56 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Ketamine for Sedation in Severe Traumatic Brain Injury
Who cites it
56 citing papers in PubMed, 1 synthesis or guideline pooled it, 115 citations in OpenAlex.
- The Impact of Invasive Brain Oxygen Pressure Guided Therapy on the Outcome of Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis.Neurocritical care · 2022Pooled it
- A pilot clinical study to estimate intracranial pressure utilising cerebral photoplethysmograms in traumatic brain injury patients.Acta neurochirurgica · 2024Trial
- An Update on Osmotherapy in Acute Brain Injury: Current and Emerging Strategies.Journal of clinical medicine · 2026Review
- A Harmonised Protocol for the Use of PRx in Adult and Paediatric TBI Patients with ICP Monitoring: CLINICCA Workgroup Output.Neurocritical care · 2026Article
- Estimation of Intracranial Elasticity and Venous Outflow Resistance from Arterial Pressure and ICP Waveforms in Severe Brain Injury.Neurocritical care · 2026Article
- Neurofilament Light Protein: A Marker for Injury Severity, Clinical Course, and Outcome Following Moderate to Severe Traumatic Brain Injury.Neurocritical care · 2026Article
- Detection of regional disparity in cerebrovascular reactivity using a custom whole brain functional near-infrared spectroscopy based mapping system: A prospective observational study.PLOS digital health · 2026Article
- Intracranial pressure toxicity: a matter of dose, not thresholds.Intensive care medicine · 2026Article
- Efficacy and Predictors of Success of External Ventricular Drainage for the Management of Traumatic Intracranial Hypertension: A Retrospective Multicenter Cohort Study.Neurocritical care · 2026Article
- Personalized treatment approaches in neurocritical care.Acute and critical care · 2026Article
- KidsBrainIT: Visualization of the Impact of Cerebral Perfusion Pressure Insult Intensity and Duration on Childhood Brain Trauma Outcome.Neurocritical care · 2026Article
- Liberal Versus Restrictive Blood Transfusion Strategies in Neurocritical Care: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Critical care research and practice · 2026Article
- Intracranial pressure, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein, and D-dimer mortality predictors in isolated severe traumatic brain injury.Surgical neurology international · 2026Article
- Prognostic value of early intracranial pressure curve following surgical decompression: A machine learning analysis.Brain & spine · 2026Article
- External Lumbar Drainage to Abort Severe Traumatic IntraCranial Hypertension Phase 1 Randomized Clinical Trial: Scientific Rationale and Methodology: An MTBINeurosurgery practice · 2025Article
- Management of intracranial hypertension with and without invasive intracranial pressure monitoring.World journal of critical care medicine · 2025Review
- Time-Domain Analysis of Low- and High-Frequency Near-Infrared Spectroscopy Sensor Technologies for Characterization of Cerebral Pressure-Flow and Oxygen Delivery Physiology: A Prospective Observational Study.Sensors (Basel, Switzerland) · 2025Observational
- Optimal mean arterial pressure and its objective statistical associations with clinical outcomes and multimodal monitoring cerebral physiology: A systematic scoping review.Physiological reports · 2025Article
- Rethinking the clinical impact of timing in ICP monitoring initiation.Critical care (London, England) · 2025Article
- Time-Series Autoregressive Models for Point and Interval Forecasting of Raw and Derived Commercial Near-Infrared Spectroscopy Measures: An Exploratory Cranial Trauma and Healthy Control Analysis.Bioengineering (Basel, Switzerland) · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors at 7 institutions in 7 countries.
Funding
Abstract
Magnitude of intracranial pressure (ICP) elevations and their duration have been associated with worse outcomes in patients with traumatic brain injuries (TBI), however published thresholds for injury vary and uncertainty about these levels has received relatively little attention. In this study, we have analyzed high-resolution ICP monitoring data in 227 adult patients in the CENTER-TBI dataset. Our aim was to identify thresholds of ICP intensity and duration associated with worse outcome, and to evaluate the uncertainty in any such thresholds. We present ICP intensity and duration plots to visualize the relationship between ICP events and outcome. We also introduced a novel bootstrap technique to evaluate uncertainty of the equipoise line. We found that an intensity threshold of 18 ± 4 mmHg (2 standard deviations) was associated with worse outcomes in this cohort. In contrast, the uncertainty in what duration is associated with harm was larger, and safe durations were found to be population dependent. The pressure and time dose (PTD) was also calculated as area under the curve above thresholds of ICP. A relationship between PTD and mortality could be established, as well as for unfavourable outcome. This relationship remained valid for mortality but not unfavourable outcome after adjusting for IMPACT core variables and maximum therapy intensity level. Importantly, during periods of impaired autoregulation (defined as pressure reactivity index (PRx)>0.3) ICP events were associated with worse outcomes for nearly all durations and ICP levels in this cohort and there was a stronger relationship between outcome and PTD. Whilst caution should be exercised in ascribing causation in observational analyses, these results suggest intracranial hypertension is poorly tolerated in the presence of impaired autoregulation. ICP level guidelines may need to be revised in the future taking into account cerebrovascular autoregulation status considered jointly with ICP levels.
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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.