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Temporal profile of intracranial pressure and cerebrovascular reactivity in severe traumatic brain injury and association with fatal outcome: An observational study

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  • Hadie Adams
  • Joseph Donnelly
  • Marek Czosnyka
  • Angelos G Kolias
  • Adel Helmy
  • David K Menon
  • Peter Smielewski
  • Peter J Hutchinson

Abstract

Background: Both intracranial pressure (ICP) and the cerebrovascular pressure reactivity represent the dysregulation of pathways directly involved in traumatic brain injury (TBI) pathogenesis and have been used to inform clinical management. However, how these parameters evolve over time following injury and whether this evolution has any prognostic importance have not been studied. Methods and findings: We analysed the temporal profile of ICP and pressure reactivity index (PRx), examined their relation to TBI-specific mortality, and determined if the prognostic relevance of these parameters was affected by their temporal profile using mixed models for repeated measures of ICP and PRx for the first 240 hours from the time of injury. A total of 601 adults with TBI, admitted between September 2002 to January 2016, and with high-resolution continuous monitoring from a single centre, were studied. At 6 months postinjury, 133 (19%) patients had a fatal outcome; of those, 88 (78%) died from nonsurvivable TBI or brain death. The difference in mean ICP between those with a fatal outcome and functional survivors was only significant for the first 168 hours after injury (all p

Suggested Citation

  • Hadie Adams & Joseph Donnelly & Marek Czosnyka & Angelos G Kolias & Adel Helmy & David K Menon & Peter Smielewski & Peter J Hutchinson, 2017. "Temporal profile of intracranial pressure and cerebrovascular reactivity in severe traumatic brain injury and association with fatal outcome: An observational study," PLOS Medicine, Public Library of Science, vol. 14(7), pages 1-21, July.
    • Handle: RePEc:plo:pmed00:1002353
    DOI: 10.1371/journal.pmed.1002353
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