Prognostic value of intracranial pressure monitoring for the management of hypertensive intracerebral hemorrhage following minimally invasive surgery

doi:10.5847/wjem.j.1920-8642.2020.03.007

Abstract

Abstract:

BACKGROUND: The incidence of hypertensive intracerebral hemorrhage (HICH) has been increasing during the recent years in low- and middle-income countries. With high mortality and morbidity rates, it brings huge burden to the families. It lacks evidence regarding the application of intracranial pressure (ICP) monitoring in HICH. In the current study, the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.

METHODS: A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine, between 2014 and 2016, was performed. The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.

RESULTS: ICP monitors were inserted into 50 patients. Patients with ICP monitoring had a significantly better outcome (P<0.05). The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring (16.68 days vs. 20.47 days, P<0.05). Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly (16.0% vs. 15.1%, P=0.901). On univariate analysis, age, Glasgow Coma Scale (GCS) on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.

CONCLUSION: ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring. Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.

Key words: Hypertensive intracerebral hemorrhage, Intracranial pressure, Minimally invasive surgery

Xiao-ru Che, Yong-jie Wang, Hai-yan Zheng. Prognostic value of intracranial pressure monitoring for the management of hypertensive intracerebral hemorrhage following minimally invasive surgery[J]. World Journal of Emergency Medicine, 2020, 11(3): 169-173.

Figures/Tables 4

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Figure 1.

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Variables	ICP monitoring	No ICP monitoring	P value
Number	50	66
Age (years)	60.7±9.36	62.5±9.28	0.084
Male gender, n (%)	28 (56)	36 (54.5)	0.876
Comorbidities, n (%)
Diabetes	12 (24)	13 (19.7)	0.577
Ischemic heart disease	7 (14)	10 (15.2)	0.862
Coagulopathy	7 (14)	9 (13.6)	0.955
GCS score (interquartile)	7 (6-7.75)	7 (6-8)	0.338
Hematoma volume (mL)	42.60±7.86	43.92±7.80	0.357
Midline shift (mm)	7.52±1.62	7.45±1.54	0.931
Left side, n (%)	27 (54)	32 (48.5)	0.556
Re-operation, n (%)	4 (8)	5 (7.6)	1
In-hospital duration (days)	16.68 (6.04)	20.47 (13.97)	0.018
Mortality, n (%)	8 (16.0)	10 (15.1)	0.901
GOS (interquartile)	3 (2-4)	3 (2-3)	0.023
CNS infection, n (%)	7 (14)	4 (6.1)	0.260

Variables	Outcome		P value
Variables	Good	Bad	P value
Number	34	82
Age (years)	55.2 (9.3)	65.8 (7.8)	<0.001
Male gender, n (%)	20 (58.8)	44 (53.7)	0.611
Comorbidities, n (%)
Diabetes	10 (29.4)	15 (18.3)	0.407
Ischemic heart disease	4 (11.8)	13 (15.9)	0.781
Coagulopathy	4 (11.8)	12 (14.6)	0.911
GCS score (interquartile)	8 (7-9)	6 (6-7)	<0.001
Hematoma volume (mL)	38.8 (6.1)	45.3 (7.7)	<0.001
Midline shift (mm)	6.6 (1.03)	7.8 (1.61)	<0.001
Left side, n (%)	21 (61.8)	38 (46.3)	0.130
ICP monitor, n (%)	21 (61.8)	13 (15.9)	0.009
Re-operation, n (%)	2 (5.9)	7 (8.5)	0.916
In-hospital duration (days)	18.5 (4.3)	19.0 (13.3)	0.662

Variables	OR (95% CI)	P value
Good outcome
Age	0.916 (0.851-0.985)	0.018
GCS score	8.827 (3.414-22.821)	<0.001
Hematoma volume	NA	0.48
Midline shift	NA	0.57
ICP monitoring	17.167 (3.075-95.833)	0.001