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

2023; Springer Science+Business Media; Volume: 49; Issue: 1 Linguagem: Inglês

10.1007/s00134-022-06937-1

1432-1238

Chiara Robba, Francesca Graziano, Angelo Guglielmi, Paola Rebora, Stefania Galimberti, Fabio Silvio Taccone, Giuseppe Citerio, Walter Videtta, G. Domeniconi, María Estrella Giménez, Mariela Fumale, Edgar Daniel Amundarain, Matías Casanova, Michael C. Reade, Elizabeth Hallt, David Pearson, Ian Seppelt, Raimund Helbok, Valery Davidovich, Geert Meyfroidt, Ilaria Alice Crippa, Liese Mebis, Patrick Biston, Stijn Van de Velde, Glorieux Denis, Pedro Kurtz, Sâmia Yasin Wayhs, Mypinder S. Sekhon, Donald Griesdale, Andrea Rigamonti, José Miguel Montes, Rodrigo Pérez-Araos, Jorge Mejía-Mantilla, Andrés Gempeler, Ray Mendoza, Nataša Kovač, Hedgar Berty Gutiérrez, Věra Špatenková, Marek Fencl, Roman Gál, Ondřej Hrdý, Kamil Vrbica, Josef Škola, Eva Provaznikova, Jakub Kletečka, P. Lavicka, Věra Špatenková, Piergiorgio Bresil, Marianne Levin, Piergiorgio Bresil, Josefine Thomsen, Thomas Egmose Larsen, H Hoffmeyer, Morten Olskjær Holm, J. Andersen, Birgitte Majholm, Margit Smitt, Heidi Shil Eddelien, Manuel Jibaja, Freddy Maldonado, María Fernanda García, Karim Asehnoune, Bertrand Pons, Gérard Audibert, Manon Lucca, Guillaume Besch, Pierluigi Banco, Karim Asehnoune, Raphaël Cinotti, Hervé Q uintard, Benjamin Soyer, Anaïs Caillard, Clément Gakuba, Romain Sonneville, Stefan Wolf, Kristina Fuest, Lea Albrecht, Sarah Grotheer, Sandro M. Krieg, Stefan J. Schaller, Charikleia S. Vrettou, Eftychia Kontoudaki, Anna Efthymiou, Elena Palli, Demosthènes Makris, Chrysi Diakaki, Christina Iasonidou, Aikaterini Dimoula, Georgios Koukoulitsios, G. Kyriazopoulos, Nikolas Pantelas, S Tsikriki, E Stamou, Charikleia S. Vrettou, Achileas Giannopoulos, Eleni Mouloudi, Hoi‐Ping Shum, Yan Chan Cheuk, Hewa Kandamby Darshana, Krisztián Tánczos, Gábor Nardai, Zoltán Szentkereszty, Harsh Sapra, Deepak Gupta, Kaveri Sharma, Saurabh Anand, Ankur Luthra, Summit Bloria, Rajeev Chauhan, Nidhi Panda, Ahmad Ozair, Bram Kilapong, Anass Alsudani, Giuseppe Citerio, Alessandra Soragni, Alessandro Motta, Andrea Marudi, Elisabetta Bertellini, Anselmo Caricato, Camilla Gelormini, Eleonora Ioannoni, Eleonora Stival, Serena Silva, Federico Pozzi, Iole Brunetti, Andrea Cortegiani, Edoardo Picetti, Federico Villa, Italo Calamai, Maria Chiara Casadio, M Quartarone, Marina Grandis, Federico Magni, Silvia Del Bianco, Claudia Bonetti, Virginia Buldini, Aimone Giugni, Simone Maria Zerbi, Marco Carbonara, Antonella Cotoia, Antonio Izzi, Oļegs Sabeļņikovs, Muhammed Elhadi, Hazem Ahmed, Silvio A. Ñamendys‐Silva, Gilberto Adrian Gasca López, Gentle Sunder Shrestha, Shirish Maskey, Tamanna Bajracharya, Khadka Nilam, Prakash Kafle, Laleet Rajbanshi, Yam Bahadur Roka, Olufemi E. Idowu, Khan Muhammad Mukhtar, Juan Luis Pinedo Portilla, Klaudyna Kojder, Irene Aragão, R.G.B.D.O.N. Freitas, Marco Simões, Dario Batista, Cecília Pacheco, Fátima Assunção, Luís Lencastre, Pedro Cavaleiro, Mohamed Abdelaty, А. И. Грицан, Sergey Khomiakov Sergey, Dovbysh Nikolay, Yaseen M. Arabi, Primož Gradišek, Petra Forjan, Mara Škoti, Suada Fileković Ribarič, Primož Gradišek, Nataša Milivojevic, Sergeja Kozar, Rafael Badenes, Aaron Blandino Ortíz, Mikel Celaya Lopez, Laurą Galarza, Luisa Corral, Africa Lores, Ricard Soley, Laura Pariente, Pablo López Ojeda, Maria Dolores Arias Verdu, Luis Javier Yuste Dominguez, Maria Isabel Gonzalez Perez, Mireia Anglada, Patricia Duque, Ainhoa Serrano, Berta Monleón, Vanessa Blázquez, Mauro Oddo, Samia Abed Maillard, Paola Morelli, John‐Paul Miroz, Eva Favre, Walid Sellami, Massimo Lamperti, Jamil Dibu, Richard Sivities, Angelos G. Kolias, Chris Thompson, Christopher Hawthorne, Justin Roberts, Lara Prisco, Roger Lightfoot, José I. Suárez, Luci Rivera-Lara, Susanne Muehlschlegel, Juan David Vega Padilla, Sanjeev Sivakumar, DaiWai M. Olson,

Neurosurgical Procedures and Complications

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.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.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.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.