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Analysis of Normal High-Frequency Intracranial Pressure Values and Treatment Threshold in Neurocritical Care Patients

By Currents Editor posted 07-01-2020 10:25

  

JAMA Neurology (06/15/20) doi: 10.1001/jamaneurol.2020.1310

Hawryluk, Gregory W. J.; Jessica L. Nielson; Huie, J. Russell; et al.

https://jamanetwork.com/journals/jamaneurology/article-abstract/2767085

To better understand the association between intracranial pressure (ICP) and outcome, researchers conducted a prospective observational study involving 523 ICP-monitored patients. The study was conducted over a 6-year period at a single level I trauma center. Participants included 383 patients with a traumatic brain injury, with or without craniectomy, and 140 with another indication for ICP monitoring. Using a computer system to prospectively and automatically record 1-minute physiologic data from patients in the intensive care unit, the researchers calculated mean ICP and the proportion of ICP values greater than thresholds from 1-80 mm Hg in 1–mm Hg increments. Elastic net regression was used to determine the ICP thresholds most strongly associated with Glasgow Outcome Scale score at hospital discharge. Based on 4.09 million 1-minute ICP measurements, ICP values of 8-9 mm Hg were recorded most frequently and potentially could reflect normal values, according to the authors, while an ICP threshold of 19 mm Hg was most strongly linked to outcome among all patient groups. ICP values higher than this threshold were associated with mortality, and lower values were tied to outcome for surviving patients.

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