THE VALUE OF TELEMETRIC INTRACRANIAL PRESSURE MONITORING IN SEVERE BRAIN TRAUMA PATIENTS
Severe traumatic brain injury (TBI), the “silent epidemic” is a public health concern as it contributes the most to death and disability globally among all trauma-related injuries. Brain Trauma Foundation (BTF) released in 2020 the Seattle International Sever Traumatic Brain Injury Consensus Conference (SIBICC) that consist of high-quality evidence reports and three distinct treatment protocols for the management of severe TBI (sTBI). Intracranial pressure (ICP) monitoring is valuable for neurocritical care and patient outcome. The purpose of this study was to assess the outcome of 19 patients with ICP and analyze the benefits of telemetric intracranial pressure monitoring. Traumatic brain injury patients admitted to our hospital that underwent ICP monitoring with Neurovent-P-tel, an improved way of monitoring ICP and proving neurocritical care. Analyzed variables were demographics, mechanism of injury, Glasgow Coma Scale (GCS), head injury specifics, ICP measures and days of ICP monitoring. Material and methods: We included in the study 19 patients from our NICU (neurointesive care unit) (15 males and 4 females). Median age was 42 (75-15) years and mean days of telemetric monitoring 2 (1-8). The majority of the patients were involved in motor vehicle accidents (12), but other causes were included (4 falls, 1 assault, 1 epilepsy related, 1 unknown). Results: The 19 implanted telemetric sensors functioned well during the NICU admission with no documented complications. We found that ICP telemetric monitoring had benefits to the patient outcomes. Conclusions: In our experience, telemetric ICP monitoring is safe to use in a traumatic neurosurgical event. Larger studies need to be made in order for this method to be used as standard care.
2. Peeters W, et al. Epidemiology of traumatic brain injury in Europe. Acta Neurochir (Wien) 2015. 157(10): 683-696.
3. Nguyen R, et al. The International Incidence of Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Can J Neurol Sci 2016; 43(6): 774-785.
4. Saul TG, Ducker TB. Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg 1982; 56(4): 498-503.
5. Weintraub AH, Gerber DJ, Kowalski RG. Posttraumatic Hydrocephalus as a Confounding Influence on Brain Injury Rehabilitation: Incidence, Clinical Characteristics, and Outcomes. Arch Phys Med Rehabil 2017; 98(2): 312-319.
6. Kammersgaard LP, Linnemann M, TibaekM. Hydrocephalus following severe traumatic brain injury in adults. Incidence, timing, and clinical predictors during rehabilitation. Neuro Rehabilitation 2013; 33(3): 473-480.
7. Lilja-Cyron A, et al. Feasibility of Telemetric Intracranial Pressure Monitoring in the Neuro Intensive Care Unit. J Neurotrauma 2018; 35(14): 1578-1586.
8. Alexander M. Observations on the structure and function of the nervous system. Creech and Johnson 1783.
9. George K. An account of the appearances observed in the dissection of two of the three individuals presumed to have perished in the storm of the 3rd, and whose bodies were discovered in the vicinity of the Leith on the morning of the 4th of November 1821 with some reflections on the pathology of the brain. Transac Medico Chirurg Soc Edinburgh 1824; 1: 84-169.
10. Nag DS, et al. Intracranial pressure monitoring: Gold standard and recent innovations. World J Clin Cases 2019; 7(13): 1535-1553.
11. ***Foundation., T.B.T., The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Indications for intracranial pressure monitoring. J Neurotrauma 2000; 17(6-7): 479-491.
12. ***Foundation., T.B.T., The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Intracranial pressure treatment threshold. J Neurotrauma 2000; 17(6-7): 493-495.
13. Hawryluk GWJ, et al. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med 2019; 45(12): 1783-1794.
14. Khormi YH, et al. Adherence to brain trauma foundation guidelines for intracranial pressure monitoring in severe traumatic brain injury and the effect on outcome: A population-based study. Surg Neurol Int 2020; 11: 118.
15. Omidbeigi M, et al. Telemetric Intracranial Pressure Monitoring: A Systematic Review. Neurocrit Care, 2020, online ahead of print.
16. Freimann FB, et al. Feasibility of telemetric ICP-guided valve adjustments for complex shunt therapy. Childs Nerv Syst 2014; 30(4): 689-697.
17. Barber JM, et al., Telemetric intra-cranial pressure monitoring: clinical and financial considerations. Br J Neurosurg 2017; 31(3): 300-306.
18. Antes, S., et al. Telemetric Intracranial Pressure Monitoring with the Raumedic Neurovent P-tel. World Neurosurg 2016; 91: 133-148.
19. Aiolfi A, et al.Brain Trauma Foundation Guidelines for Intracranial Pressure Monitoring: Compliance and Effect on Outcome. World J Surg 2017; 41(6): 1543-1549.
20. Miller JD, et al. Significance of intracranial hypertension in severe head injury. J Neurosurg 1977; 47(4): 503-516.
21. Ah R, et al. The Association of Intracranial Pressure Monitoring and Mortality: A Propensity Score-Matched Cohort of Isolated Severe Blunt Traumatic Brain Injury. J Emerg Trauma Shock 2019; 12(1): 18-22.
22. Al Saiegh F, et al. Comparison of Outcomes of Severe Traumatic Brain Injury in 36,929 Patients Treated with or without Intracranial Pressure Monitoring in a Mature Trauma System. World Neuro-surg 2020; 136: e535-e541.
23. Areas FZ, et al. Predictors of Hospital Mortality and the Related Burden of Disease in Severe Traumatic Brain Injury: A Prospective Multicentric Study in Brazil. Front Neurol 2019; 10: 432.
24. Tavakoli S, et al. Complications of invasive intracranial pressure monitoring devices in neurocritical care. Neurosurg Focus 2017; 43(5): E6.
Once an article is accepted for publication, MSJ requests a transfer of copyrights for published articles.
COPYRIGHT TRANSFER FORM FOR
REVISTA MEDICO-CHIRURGICALĂ A SOCIETĂȚII DE MEDICI ȘI NATURALIȘTI DIN IAȘI /
THE MEDICAL-SURGICAL JOURNAL OF THE SOCIETY OF PHYSICIANS AND NATURALISTS FROM IASI
We, the undersigned authors of the manuscript entitled
warrant that this manuscript, which is submitted for publication in the REVISTA MEDICO-CHIRURGICALĂ, has not been published and it is not under consideration for publication in another journal.
- we give the consent for publication in the REVISTA MEDICO-CHIRURGICALĂ, in printed and electronic format and we transfer unconditioned and complete the copyright of this manuscript to the REVISTA MEDICO-CHIRURGICALĂ, in the event of its acceptance.
- the manuscript does not break the intellectual property rights of any other person.
- we have read the submitted version of the manuscript and we are fully responsible for the content.
Names and signatures of authors / copyright owners (the following sequence is the authorship of the article):
N.B. All the authors must sign this form