Una revisión sistemática del monitoreo de la presión intracraneana en adultos con trauma craneoencefálico severo / A systematic review of intracranial pressure monitoring in adults with severe traumatic brain injury

Objetivos: Revisar sistemáticamente la evidencia relacionada con el monitoreo de la presion intracraneana en unidades de cuidado neurocrítico en el contexto de trauma craneoencefálico severo. Criterios de elección: Ensayos clínicos aleatorizados que comparen el uso del monitoreo de la presión intracraneana (PIC) que muestren un estimado de mortalidad/discapacidad a 6 meses, en pacientes mayores de 12 años de edad con trauma craneoencefálico severo (escala de Glasgow menor a 8). Método de búsqueda: En Medline, el Registro Central de Ensayos Controlados (CENTRAL); PubMed, HINARI, EMBASE; Grupo Cochrane de Lesiones y las listas de referencias de artículos. De acuerdo con el Manual Cochrane para meta-análisis y revisión sistemática. Resultados: No hubo diferencias entre el grupo de PIC y el control en el pronóstico de discapacidad (RR [Riesgo Relativo]1.01, 95 por ciento CI 0.87 to 1.18). Sin embargo, el monitoreo de la PIC reduce la estancia en UCI en comparación con otros métodos. La estancia en UCI con tratamiento cerebral específico también se redujo en comparación con grupo control. Conclusiones: En pacientes con trauma craneoencefálico, no hubo diferencia entre el monitoreo de la PIC y el examen clínico sin embargo, para mantener una PIC baja, hubo una sustancial reducción de requerimiento de solución salina hipertónica y un descenso en la hiperventilación trayendo consigo beneficios para pacientes en UCI.

Objectives: To systematically review the evidence of intracranial pressure monitoring in neuro critical care unit in the context of a severe head injury. Study eligibility criteria: Patients were older than 12 years ,had a severe traumatic brain injury (Glasgow coma scale < 8), that compared the use of ICP monitoring with control, that presented an estimate of mortality/ disability prognosis 6 months after injury.only randomized clinical trials. Methods: Searched MEDLINE, the Central Registerof Controlled Trials (CENTRAL); PubMed, HINARI,EMBASE; Cochrane Injuries group and the reference lists of articles. In accordance with the Cochrane handbook for meta-analysis and systematic review. Results: In the ICP and control groups there was no difference in the prognosis of disability (RR [Relative Risk]1.01, 95 percent CI 0.87 to 1.18). However, ICP monitoring reduced the duration of stay in ICU compared to other surveillance methods. The stay in the ICU with specific medical support for brain injury was also reduced compared to the control group. Conclusions: In patients with severe traumatic brain injury, the ICP monitoring was not difference to imaging and clinical examination. However, by keeping the ICP low there was a substantial reduction in the requirement for hypertonic saline and a decrease in hyperventilation providing benefits to thepatient in the ICU.

The Roll of Continuous ICP Monitoring for the Application of Shunt Operation in Adult Ventriculomegaly Patients

We evaluated one month follow-up results of the 12 adult patients who showed ventriculomegaly in the aspects of symptoms. Evans ratio, periventricular low density, grades of radio-isotope cisternography, and grades of continuous intracranial pressure monitoring that were classified on the pressure wave and basal pressure level. The grades of continuous ICP monitoring were compared to the grades of radio-isotope cisternography. History, symptoms, CT findings, and radio-isotope cisternography are often helpful to decide shunt operation but sometimes continuous intracranial pressure monitoring gives invaluable information.

Comparison of Intracranial Pressure on Different Monitoring Sites

To compare intrahematomal pressure(IH) with epidural pressure(EP), lumbar subarachnoid pressure(LP) and intraventricular pressure(IV), 34 intracerebral hemorrhage patients from Dec. 1986 to Aug. 1987 were selected. We measured IH via stereotacically placed catheter and at the same time, we measured EP with fiberoptic sensor, LP by lumbar puncture and IV via stereotactically placed catheter during communication between hematoma and ventricle. The results obtained were as follows : 1) IH was the highest in most cases and IH, IV, LP and EP in orders by mean values. 2) In distribuion of EP, LP and IV compared with IH, EP had wide range of distribution(17~500%) compared to LP and IV. 3) There was a tendency of increased rate of higher IH than EP according to increased size of hematoma. 4) There was a tendency of increased rate of higher IH than EP in thalamic hemorrhage than putaminal hemorrhage. 5) ICP curves showed abrupt increase or decrease in cases of rebleeding or communication between hematoma and ventricle. 6) In analysis of low IH compared with EP and LP, the causes were due to checking of IH just after aspiration of large amount of hematoma(3 cases) and normal variations(6 cases). 7) In analysis of failed monitoring, EP was 5 cases(19%) and IH was 3 cases(8.8%) so more failed monitoring were found in EP than IH and there was no failed cases in LP and IV. From above results, we concluded that IH was the highest in most cases and EP was less reliable than other pressures.