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

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...

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Bibliographic Details
Published in:Intensive care medicine 2023, Vol.49 (1), p.50-61
Main Authors: Robba, Chiara, Graziano, Francesca, Guglielmi, Angelo, Rebora, Paola, Galimberti, Stefania, Taccone, Fabio S., Citerio, Giuseppe
Format: Article
Language:English
Subjects:
Analysis
Anesthesiology
Argentina
Belgium
Brain
Brain Injuries, Traumatic - complications
Brain Injuries, Traumatic - therapy
Comorbidity
Critical Care Medicine
Czech Republic
Drug therapy
Emergency Medicine
Female
France
Glasgow Coma Scale
Greece
Humans
Hypertension
India
Injuries
Intensive
Intensive care
Intensive Care Units
Intracranial hypertension
Intracranial Hypertension - etiology
Intracranial Hypertension - therapy
Intracranial Pressure
Male
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Middle Aged
Monitoring, Physiologic
Mortality
NCT
NCT03257904
Nepal
Original
Pain Medicine
Patient outcomes
Pediatrics
Pneumology/Respiratory System
Portugal
Prospective Studies
Slovenia
Spain
Traumatic brain injury
United Kingdom
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Summary: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  
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-022-06937-1