Evidence map›Paper›PMID 34405321›Full record

ArticleNeurocritical care2022

Verticalization for Refractory Intracranial Hypertension: A Case Series.

Brittany Bolduc Lachance, WanTsu Chang, Melissa Motta, Gunjan Parikh, Jamie Podell, Neeraj Badjatia, J Marc Simard, Gary T Schwartzbauer, Nicholas A Morris

Abstract read
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In one paragraph

Article in Neurocritical care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.5field-weighted citation impact, top 42% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 6 citations in OpenAlex.

  1. Article
  2. Mobilization in Neurocritical Care: Challenges and Opportunities.Current neurology and neuroscience reports · 2024
    Review
  3. Article
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

Brittany Bolduc LachanceProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. blachance@som.umaryland.edu.ORCID 0000-0002-2430-862X
WanTsu ChangProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
Melissa MottaProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
Gunjan ParikhProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
Jamie PodellProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
Neeraj BadjatiaProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
J Marc SimardDepartment of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
Gary T SchwartzbauerDepartment of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
Nicholas A MorrisProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
University of Maryland, Baltimore · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSevere intracranial hypertension is strongly associated with mortality. Guidelines recommend medical management involving sedation, hyperosmotic agents, barbiturates, hypothermia, and surgical intervention. When these interventions are maximized or are contraindicated, refractory intracranial hypertension poses risk for herniation and death. We describe a novel intervention of verticalization for treating intracranial hypertension refractory to aggressive medical treatment.

methodsThis study was a single-center retrospective review of six cases of refractory intracranial hypertension in a tertiary care center. All patients were treated with a standard-of-care algorithm for lowering intracranial pressure (ICP) yet maintained an ICP greater than 20 mmHg. They were then treated with verticalization for at least 24 h. We compared the median ICP, the number of ICP spikes greater than 20 mmHg, and the percentage of ICP values greater than 20 mmHg in the 24 h before verticalization vs. after verticalization. We assessed the use of hyperosmotic therapies and any changes in the mean arterial pressure and cerebral perfusion pressure related with the intervention.

resultsFive patients were admitted with subarachnoid hemorrhage and one with intracerebral hemorrhage. All patients had ICP monitoring by external ventricular drain. The median opening pressure was 30 mmHg (25th-75th interquartile range 22.5-30 mmHg). All patients demonstrated a reduction in ICP after verticalization, with a significant decrease in the median ICP (12 vs. 8 mmHg; p < 0.001), the number of ICP spikes (12 vs. 2; p < 0.01), and the percentage of ICP values greater than 20 mmHg (50% vs. 8.3%; p < 0.01). There was a decrease in total medical interventions after verticalization (79 vs. 41; p = 0.05) and a lower total therapy intensity level score after verticalization. The most common adverse effects included asymptomatic bradycardia (n = 3) and pressure wounds (n = 4).

conclusionsVerticalization is an effective noninvasive intervention for lowering ICP in intracranial hypertension that is refractory to aggressive standard management and warrants further study.

Indexed as

Intracranial HypertensionSubarachnoid HemorrhageBarbituratesCerebrovascular CirculationHumansIntracranial PressureBarbituratesBrain edemaIntracranial hypertensionIntracranial pressure

Identifiers

PMID34405321
OpenAlexW3193760909

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.