Observational studyIntensive care medicine2023
Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study.
Observational study in Intensive care medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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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.
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Who cites it
17 citing papers in PubMed.
- Variation in capability, organisational structure, and treatment processes for critically ill adults with moderate-to-severe traumatic brain injury in Australia and New Zealand.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- What Do We Do When the ICP Goes Up?Neurocritical care · 2026Observational
- Intracranial Pressure Estimation Using B4C Device: A Systematic Review on the Validation Studies.Neurocritical care · 2026Review
- Article
- Update on acute brain injury.Intensive care medicine · 2025Article
- Evolution from Decompressive Craniectomy to Early Minimally Invasive Surgical Approach for Refractory Increased Intracranial Pressure Treatment: Merit or Social Problems?Turkish journal of anaesthesiology and reanimation · 2025Article
- Traumatic brain injury management in the intensive care unit: standard of care and knowledge gaps.Intensive care medicine · 2025Review
- Update on traumatic brain injury in the ICU.Current opinion in anaesthesiology · 2025Review
- Staircase strategy, tier-three therapies, and effects on outcome in traumatic brain injured patients: the Triple-T TBI study.Intensive care medicine · 2025Observational
- Ventilation practices in acute brain injured patients and association with outcomes: the VENTIBRAIN multicenter observational study.Intensive care medicine · 2025Observational
- The Brussels consensus for non-invasive ICP monitoring when invasive systems are not available in the care of TBI patients (the B-ICONIC consensus, recommendations, and management algorithm).Intensive care medicine · 2025Article
- Managing Intracranial Pressure Crisis.Current neurology and neuroscience reports · 2024Review
- Brain tissue oxygen monitoring in moderate-to-severe traumatic brain injury: Physiological determinants, clinical interventions and current randomised controlled trial evidence.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2024Review
- Therapy Intensity Level Scale for Traumatic Brain Injury: Clinimetric Assessment on Neuro-Monitored Patients Across 52 European Intensive Care Units.Journal of neurotrauma · 2024Article
- Positive end-expiratory pressure increases intracranial pressure but not pressure reactivity index in supine and prone positions: a porcine model study.Frontiers in medicine · 2024Article
- Intracranial Pressure Monitoring and Management in Aneurysmal Subarachnoid Hemorrhage.Neurocritical care · 2023Review
- Academic neurosurgery in Nepal: Present status and future directions.Brain & spine · 2023Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeUncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome.
methodsA preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission.
results2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles = 35-62) vs 56 (40-69) years, p < 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p < 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p < 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p < 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR = 1.612, 95% Confidence Interval, CI = 1.243-2.091, p < 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR = 1.017, 95% CI = 0.823-1.257, p = 0.873). No significant association between the use of TIL and neurological outcome was observed.
conclusionsDuring the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome.
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