Skip to main content
Erschienen in:

05.12.2022 | Original Work

Intracranial Pressure Monitoring Practice, Treatment, and Effect on Outcome in Aneurysmal Subarachnoid Hemorrhage

verfasst von: Marta Baggiani, Francesca Graziano, Paola Rebora, Chiara Robba, Angelo Guglielmi, Stefania Galimberti, Carlo Giussani, Jose I. Suarez, Raimund Helbok, Giuseppe Citerio

Erschienen in: Neurocritical Care | Ausgabe 3/2023

Einloggen, um Zugang zu erhalten

Abstract

Background

Intracranial pressure (ICP) monitoring and its management in aneurysmal subarachnoid hemorrhage (aSAH) is variable worldwide. The present study aimed to explore the practice of ICP monitoring, its variability across countries, and the association with 6-month outcomes in aSAH.

Methods

This was a preplanned subanalysis of SYNAPSE-ICU, a multicenter, international, prospective, observational cohort study focused on patients diagnosed with aSAH. We evaluated the variability in ICP monitoring across countries through a logistic regression model adjusted for case-mix and considered countries as a random effect. The association between ICP probe insertion and 6-month mortality and a poor neurological outcome, defined as an Glasgow Outcome Score Extended ≤ 4, was assessed by using a propensity score approach.

Results

A total of 423 patients with aSAH from 92 centers across 32 countries were included in this analysis. ICP monitoring was used in 295 (69.7%) patients. Significant between-country variability in ICP insertion was observed, with an incidence ranging between 4.7% and 79.9% (median odd ratio 3.04). The median duration of ICP monitoring was 12 days (first quartile [Q1] through third quartile [Q3] range 8–18), with an overall daily median ICP value of 14 mm Hg (Q1–Q3 10–19) and a median maximum value of 21 mm Hg (Q1–Q3 16–30). Patients monitored with ICP received more aggressive therapy treatments compared with non-monitored patients (therapy intensity level, TIL, score 10.33 [standard deviation 3.61] vs. 6.3 [standard deviation 4.19], p < 0.001). In more severe patients, ICP monitoring was significantly associated with better 6-month outcome (poor neurological outcome: odds ratio 0.14, 95% confidence interval 0.02–0.53, p = 0.0113; mortality: hazard ratio 0.25, 95% confidence interval 0.13–0.49, p < 0.0001). However, no significant effect was observed in patients with both reactive pupils.

Conclusions

Our cohort demonstrated high variability in ICP insertion practice among countries. A more aggressive treatment approach was applied in ICP-monitored patients. In patients with severe aSAH, ICP monitoring might reduce unfavorable outcomes and mortality at 6 months.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Cossu G, Messerer M, Stocchetti N, Levivier M, Daniel RT, Oddo M. Intracranial pressure and outcome in critically ill patients with aneurysmal subarachnoid hemorrhage: a systematic review. Minerva Anestesiol. 2016;82:684–96.PubMed Cossu G, Messerer M, Stocchetti N, Levivier M, Daniel RT, Oddo M. Intracranial pressure and outcome in critically ill patients with aneurysmal subarachnoid hemorrhage: a systematic review. Minerva Anestesiol. 2016;82:684–96.PubMed
2.
Zurück zum Zitat Wettervik TS, Howells T, Lewén A, Ronne-Engström E, Enblad P. Temporal dynamics of ICP, CPP, PRx, and CPPopt in high-grade aneurysmal subarachnoid hemorrhage and the relation to clinical outcome. Neurocrit Care. 2021;34:390–402.CrossRef Wettervik TS, Howells T, Lewén A, Ronne-Engström E, Enblad P. Temporal dynamics of ICP, CPP, PRx, and CPPopt in high-grade aneurysmal subarachnoid hemorrhage and the relation to clinical outcome. Neurocrit Care. 2021;34:390–402.CrossRef
3.
Zurück zum Zitat Florez WA, García-Ballestas E, Deora H, Agrawal A, Martinez-Perez R, Galwankar S, et al. Intracranial hypertension in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Neurosurg Rev. 2021;44:203–11.CrossRefPubMed Florez WA, García-Ballestas E, Deora H, Agrawal A, Martinez-Perez R, Galwankar S, et al. Intracranial hypertension in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Neurosurg Rev. 2021;44:203–11.CrossRefPubMed
4.
Zurück zum Zitat Connolly ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. Stroke. 2012;43:1711–37.CrossRefPubMed Connolly ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. Stroke. 2012;43:1711–37.CrossRefPubMed
5.
Zurück zum Zitat Monitoring TP in the IMCC on M, Helbok R, Olson DM, Roux PDL, Vespa P. Intracranial Pressure and Cerebral Perfusion Pressure Monitoring in Non-TBI Patients: Special Considerations. Neurocrit Care. 2014;21:85–94. Monitoring TP in the IMCC on M, Helbok R, Olson DM, Roux PDL, Vespa P. Intracranial Pressure and Cerebral Perfusion Pressure Monitoring in Non-TBI Patients: Special Considerations. Neurocrit Care. 2014;21:85–94.
6.
Zurück zum Zitat Robba C, Graziano F, Rebora P, Elli F, Giussani C, Oddo M, et al. Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (SYNAPSE-ICU): an international, prospective observational cohort study. Lancet Neurol. 2021;20:548–58.CrossRefPubMed Robba C, Graziano F, Rebora P, Elli F, Giussani C, Oddo M, et al. Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (SYNAPSE-ICU): an international, prospective observational cohort study. Lancet Neurol. 2021;20:548–58.CrossRefPubMed
7.
Zurück zum Zitat Citerio G, Prisco L, Oddo M, Meyfroidt G, Helbok R, Stocchetti N, et al. International prospective observational study on intracranial pressure in intensive care (ICU): the SYNAPSE-ICU study protocol. BMJ Open. 2019;9: e026552.CrossRefPubMedPubMedCentral Citerio G, Prisco L, Oddo M, Meyfroidt G, Helbok R, Stocchetti N, et al. International prospective observational study on intracranial pressure in intensive care (ICU): the SYNAPSE-ICU study protocol. BMJ Open. 2019;9: e026552.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4: e297.CrossRefPubMedPubMedCentral Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4: e297.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Claassen J, Bernardini GL, Kreiter K, Bates J, Du YE, Copeland D, et al. Effect of Cisternal and Ventricular Blood on Risk of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: The Fisher Scale Revisited. Stroke. 2001;32:2012–20.CrossRefPubMed Claassen J, Bernardini GL, Kreiter K, Bates J, Du YE, Copeland D, et al. Effect of Cisternal and Ventricular Blood on Risk of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: The Fisher Scale Revisited. Stroke. 2001;32:2012–20.CrossRefPubMed
10.
Zurück zum Zitat Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg. 1988;68:985–6. Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg. 1988;68:985–6.
11.
Zurück zum Zitat Hawryluk GWJ, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, et al. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intens Care Med. 2019;45:1783–94.CrossRef Hawryluk GWJ, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, et al. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intens Care Med. 2019;45:1783–94.CrossRef
12.
Zurück zum Zitat Zuercher P, Groen JL, Aries MJH, Steyerberg EW, Maas AIR, Ercole A, et al. Reliability and Validity of the Therapy Intensity Level Scale: Analysis of Clinimetric Properties of a Novel Approach to Assess Management of Intracranial Pressure in Traumatic Brain Injury. J Neurotraum. 2016;33:1768–74.CrossRef Zuercher P, Groen JL, Aries MJH, Steyerberg EW, Maas AIR, Ercole A, et al. Reliability and Validity of the Therapy Intensity Level Scale: Analysis of Clinimetric Properties of a Novel Approach to Assess Management of Intracranial Pressure in Traumatic Brain Injury. J Neurotraum. 2016;33:1768–74.CrossRef
13.
Zurück zum Zitat Wilson L, Boase K, Nelson LD, Temkin NR, Giacino JT, Markowitz AJ, et al. A Manual for the Glasgow Outcome Scale-Extended Interview. J Neurotraum. 2021;38:2435–46.CrossRef Wilson L, Boase K, Nelson LD, Temkin NR, Giacino JT, Markowitz AJ, et al. A Manual for the Glasgow Outcome Scale-Extended Interview. J Neurotraum. 2021;38:2435–46.CrossRef
14.
Zurück zum Zitat Larsen K, Petersen JH, Budtz-Jørgensen E, Endahl L. Interpreting Parameters in the Logistic Regression Model with Random Effects. Biometrics. 2000;56:909–14.CrossRefPubMed Larsen K, Petersen JH, Budtz-Jørgensen E, Endahl L. Interpreting Parameters in the Logistic Regression Model with Random Effects. Biometrics. 2000;56:909–14.CrossRefPubMed
15.
Zurück zum Zitat Citerio G, Gaini SM, Tomei G, Stocchetti N. Management of 350 aneurysmal subarachnoid hemorrhages in 22 Italian neurosurgical centers. Intens Care Med. 2007;33:1580–6.CrossRef Citerio G, Gaini SM, Tomei G, Stocchetti N. Management of 350 aneurysmal subarachnoid hemorrhages in 22 Italian neurosurgical centers. Intens Care Med. 2007;33:1580–6.CrossRef
16.
Zurück zum Zitat Cossu G, Messerer M, Oddo M, Daniel RT. To Look Beyond Vasospasm in Aneurysmal Subarachnoid Haemorrhage. BioMed Res Int. 2014;1:1–14. Cossu G, Messerer M, Oddo M, Daniel RT. To Look Beyond Vasospasm in Aneurysmal Subarachnoid Haemorrhage. BioMed Res Int. 2014;1:1–14.
17.
Zurück zum Zitat Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006;354:387–96.CrossRefPubMed Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006;354:387–96.CrossRefPubMed
18.
Zurück zum Zitat Chou SH-Y. Subarachnoid Hemorrhage. Continuum Lifelong Learn Neurol. 2021;27:1201–45.CrossRef Chou SH-Y. Subarachnoid Hemorrhage. Continuum Lifelong Learn Neurol. 2021;27:1201–45.CrossRef
19.
Zurück zum Zitat Coppadoro A, Citerio G. Subarachnoid hemorrhage: an update for the intensivist. Minerva Anestesiol. 2011;77:74–84.PubMed Coppadoro A, Citerio G. Subarachnoid hemorrhage: an update for the intensivist. Minerva Anestesiol. 2011;77:74–84.PubMed
20.
Zurück zum Zitat Picetti E, Barbanera A, Bernucci C, Bertuccio A, Bilotta F, Boccardi EP, et al. Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)–Part 1. J Anesthesia Analgesia Critical Care. 2022;2:13.CrossRef Picetti E, Barbanera A, Bernucci C, Bertuccio A, Bilotta F, Boccardi EP, et al. Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)–Part 1. J Anesthesia Analgesia Critical Care. 2022;2:13.CrossRef
21.
Zurück zum Zitat Zoerle T, Lombardo A, Colombo A, Longhi L, Zanier ER, Rampini P, et al. Intracranial pressure after subarachnoid hemorrhage. Crit Care Med. 2015;43:168–76.CrossRefPubMed Zoerle T, Lombardo A, Colombo A, Longhi L, Zanier ER, Rampini P, et al. Intracranial pressure after subarachnoid hemorrhage. Crit Care Med. 2015;43:168–76.CrossRefPubMed
22.
Zurück zum Zitat Heuer GG, Smith MJ, Elliott JP, Winn HR, Leroux PD. Relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg. 2004;101:408–16.CrossRefPubMed Heuer GG, Smith MJ, Elliott JP, Winn HR, Leroux PD. Relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg. 2004;101:408–16.CrossRefPubMed
23.
Zurück zum Zitat Magni F, Pozzi M, Rota M, Vargiolu A, Citerio G. High-resolution intracranial pressure burden and outcome in subarachnoid hemorrhage. Stroke. 2015;46:2464–9.CrossRefPubMed Magni F, Pozzi M, Rota M, Vargiolu A, Citerio G. High-resolution intracranial pressure burden and outcome in subarachnoid hemorrhage. Stroke. 2015;46:2464–9.CrossRefPubMed
24.
Zurück zum Zitat Carra G, Elli F, Ianosi B, Flechet M, Huber L, Rass V, et al. Association of dose of intracranial hypertension with outcome in subarachnoid hemorrhage. Neurocrit Care. 2021;34:722–30.CrossRefPubMed Carra G, Elli F, Ianosi B, Flechet M, Huber L, Rass V, et al. Association of dose of intracranial hypertension with outcome in subarachnoid hemorrhage. Neurocrit Care. 2021;34:722–30.CrossRefPubMed
25.
Zurück zum Zitat Hockel K, Schuhmann MU. Intracranial Pressure & Neuromonitoring XVI. 2018. p. 281–6. Hockel K, Schuhmann MU. Intracranial Pressure & Neuromonitoring XVI. 2018. p. 281–6.
26.
Zurück zum Zitat Liu X, Griffith M, Jang HJ, Ko N, Pelter MM, Abba J, et al. Intracranial pressure monitoring via external ventricular drain: Are we waiting long enough before recording the real value? J Neurosci Nurs. 2020;52:37–42.CrossRefPubMedPubMedCentral Liu X, Griffith M, Jang HJ, Ko N, Pelter MM, Abba J, et al. Intracranial pressure monitoring via external ventricular drain: Are we waiting long enough before recording the real value? J Neurosci Nurs. 2020;52:37–42.CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Mack WJ, Hickman ZL, Ducruet AF, Kalyvas JT, Garrett MC, Starke RM, et al. Pupillary reactivity upon hospital admission predicts long-term outcome in poor grade aneurysmal subarachnoid hemorrhage patients. Neurocrit Care. 2008;8:374–9.CrossRefPubMed Mack WJ, Hickman ZL, Ducruet AF, Kalyvas JT, Garrett MC, Starke RM, et al. Pupillary reactivity upon hospital admission predicts long-term outcome in poor grade aneurysmal subarachnoid hemorrhage patients. Neurocrit Care. 2008;8:374–9.CrossRefPubMed
28.
Zurück zum Zitat Mader MM, Piffko A, Dengler NF, Ricklefs FL, Dührsen L, Schmidt NO, et al. Initial pupil status is a strong predictor for in-hospital mortality after aneurysmal subarachnoid hemorrhage. Sci Rep-uk. 2020;10:4764.CrossRef Mader MM, Piffko A, Dengler NF, Ricklefs FL, Dührsen L, Schmidt NO, et al. Initial pupil status is a strong predictor for in-hospital mortality after aneurysmal subarachnoid hemorrhage. Sci Rep-uk. 2020;10:4764.CrossRef
Metadaten
Titel
Intracranial Pressure Monitoring Practice, Treatment, and Effect on Outcome in Aneurysmal Subarachnoid Hemorrhage
verfasst von
Marta Baggiani
Francesca Graziano
Paola Rebora
Chiara Robba
Angelo Guglielmi
Stefania Galimberti
Carlo Giussani
Jose I. Suarez
Raimund Helbok
Giuseppe Citerio
Publikationsdatum
05.12.2022
Verlag
Springer US
Erschienen in
Neurocritical Care / Ausgabe 3/2023
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-022-01651-8

Kompaktes Leitlinien-Wissen Neurologie (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Neu im Fachgebiet Neurologie

Kaliumhaltiges Kochsalz schützt vor Schlaganfallrezidiven

Erhalten Menschen nach einem Schlaganfall statt normalem Kochsalz eine kaliumhaltige Alternative, reduziert dies sowohl das Risiko für erneute ischämische und hämorrhagische Insulte als auch die Gesamtmortalität. Dafür sprechen Ergebnisse einer großen randomisierten Studie.

Der Mann mit der Alzheimermutation, der keine Demenz bekommt

Nur sehr selten werden Menschen mit einer Alzheimermutation von einer familiären Demenz verschont, was meist an protektiven Genvarianten liegt. Ein über 70-jähriger Mann stellt die Forschung jedoch vor ein Rätsel. Vielleicht hat ihm die Arbeit in großer Hitze geholfen.

Auch nach TIA kommt es zu kognitivem Abbau

Trotz raschem und vollständigem Verschwinden der Symptome bergen auch transitorische ischämische Attacken das Risiko langfristigen kognitiven Abbaus, wie eine Studie zeigt. Die Größenordnung gleicht jener nach einem Schlaganfall.

Schlaganfall oder Schlaganfall-Imitator?

Ein breites Spektrum von Erkrankungen kann einen Schlaganfall vortäuschen. Bei der notwendigen schnellen Unterscheidung zwischen solchen „stroke mimics“ und echten Schlaganfällen können einige klinische Faktoren und Symptome unterstützend herangezogen werden. 

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.