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RESEARCH PRODUCT

Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

Chiara RobbaFrancesca GrazianoAngelo GuglielmiPaola ReboraStefania GalimbertiFabio S TacconeGiuseppe CiterioWalter VidettaGustavo DomeniconiMaría Estrella GiménezMariela FumaleEdgar Daniel AmundarainMatias CasanovaMichael ReadeElizabeth HalltDavid PearsonIan SeppeltRaimund HelbokValery DavidovichGeert MeyfroidtIlaria Alice CrippaLiese MebisPatrick BistonStijn Van De VeldeGlorieux DenisPedro KurtzSamia Yasin WayhsMypinder SekhonDonald GriesdaleAndrea RigamontiJosé Miguel MontesRodrigo Pérez-araosJorge H Mejia-mantillaAndrés GempelerRay MendozaNatasa KovacHedgar Berty GutiérrezVera SpatenkovaMarek FenclRoman GalOndrej HrdyKamil VrbicaJosef SkolaEva ProvaznikovaJakub KleteckaPavel LavickaVera SpatenkovaPiergiorgio BresilMarianne LevinPiergiorgio BresilJosefine ThomsenThomas Egmose LarsenHenrik Westy HoffmeyerMorten Olskjaer HolmJesper Borg AndersenBirgitte MajholmMargit SmittHeidi Shil EddelienManuel JibajaFreddy MaldonadoMaría Fernanda GarcíaKarim AsehnouneBertrand PonsGérard AudibertManon LuccaGuillaume BeschPierluigi BancoKarim AsehnouneRaphael CinottiHervé Q UintardBenjamin SoyerAnais CaillardClement GakubaRomain SonnevilleStefan WolfKristina FuestLea AlbrechtSarah GrotheerSandro M KriegStefan J SchallerCharikleia VrettouEftychia KontoudakiAnna EfthymiouElena PalliDemosthenes MakrisChrysi DiakakiChristina IasonidouAikaterini DimoulaGeorgios KoukoulitsiosGeorge KyriazopoulosNikolas PantelasSyragoula TsikrikiElectra Eleni StamouCharikleia VrettouAchileas GiannopoulosEleni MouloudiPing Shum HoiYan Chan CheukHewa Kandamby DarshanaKrisztián TánczosGabor NardaiZoltan SzentkeresztyHarsh SapraDeepak GuptaKaveri SharmaSaurabh AnandAnkur LuthraSummit BloriaRajeev ChauhanNidhi PandaAhmad OzairBram KilapongAnass AlsudaniGiuseppe CiterioAlessandra SoragniAlessandro MottaAndrea MarudiElisabetta BertelliniAnselmo CaricatoCamilla GelorminiEleonora IoannoniEleonora StivalSerena SilvaFederico PozziIole BrunettiAndrea CortegianiEdoardo PicettiFederico VillaItalo CalamaiMaria Chiara CasadioMaria Concetta QuartaroneMarzia GrandisFederico MagniSilvia Del BiancoClaudia BonettiVirginia BuldiniAimone GiugniSimone Maria ZerbiMarco CarbonaraAntonella CotoiaAntonio IzziOlegs SabelnikovsMuhammed ElhadiHazem AhmedSilvio A ÑAmendys SilvaGilberto Adrian Gasca LópezGentle S ShresthaShirish MaskeyTamanna BajracharyaKhadka NilamPrakash KafleLaleet RajbanshiYam Bahadur RokaOlufemi IdowuKhan Muhammad MukhtarJuan Luis Pinedo PortillaKlaudyna KojderIrene AragaoRicardo FreitasMarco SimoesDario BatistaCecília PachecoFátima AssunçãoLuís LencastrePedro CavaleiroMohamed AbdelatyAlex GritsanSergey Khomiakov SergeyDovbysh NikolayYaseen ArabiPrimoz GradisekPetra ForjanMara ŠKotiSuada Filekovic RibaricPrimoz GradisekNataša MilivojevicSergeja KozarRafael BadenesAaron Blandino OrtizMikel Celaya LopezLaura GalarzaLuisa CorralAfrica LoresRicard SoleyLaura ParientePablo López OjedaMaria Dolores Arias VerduLuis Javier Yuste DominguezMaria Isabel Gonzalez PerezMireia AngladaPatricia DuqueAinhoa SerranoBerta MonleonVanessa BlazquezMauro OddoSamia Abed MaillardPaola MorelliJohn-paul MirozEva FavreWalid SellamiMassimo LampertiJamil DibuRichard SivitiesAngelos KoliasChris ThompsonChristopher HawthorneJustin RobertsLara PriscoRoger LightfootJosè I SuarezLuci Rivera-laraSusanne MuehlschlegelJuan PadillaSanjeev SivakumarDaiwai Olson

subject

Subarachnoid haemorrhageTraumatic brain injuryIntracranial pressureTherapy intensity levelCritical Care and Intensive Care MedicineIntracranial haemorrhage

description

Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles = 35-62) vs 56 (40-69) years, p < 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p < 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p < 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p < 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR = 1.612, 95% Confidence Interval, CI = 1.243-2.091, p < 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR = 1.017, 95% CI = 0.823-1.257, p = 0.873). No significant association between the use of TIL and neurological outcome was observed. Conclusions: During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome.

yearjournalcountryeditionlanguage
2023-01-01Intensive Care Medicine
https://doi.org/10.1007/s00134-022-06937-1