Subdural intracranial pressure monitoring in severe head injury: clinical experience with the Codman MicroSensor.
BACKGROUND
Our main objective was to study the clinical outcome and complications of the subdural ICP monitoring with the CMS (Johnson and Johnson Medical Ltd, Raynhan, MA) in severe head injury.


METHODS
A retrospective analysis of patients with head injury with a GCS score of 8 or less was performed. Patients with severe systemic injury with hypotension (systolic blood pressure of <90 mm Hg on admission), a GCS score of 3 with fixed and dilated pupils after resuscitation, a GCS score of 3 to 4 whose family refused aggressive treatment, and those who were dead on arrival were excluded from this study. During the period from January 1997 to April 2004, 120 patients with severe head injuries were included and met criteria for insertion of a subdural ICP monitoring device (CMS).


RESULTS
A total of 120 patients (84 males and 36 females), aged 16 to 80 years old (mean, 43.8 +/- 14.4), were enrolled in the study. The average duration of ICP monitoring device use was 7.6 +/- 0.4 days (range, 2-14 days). The overall clinical outcomes of these patients were as follows: mortality rate, 13.5%; percentage of unfavorable outcomes, 17.3%; percentage of favorable outcomes, 69.2%. There were no complications such as CNS infection or hemorrhage in this study.


CONCLUSIONS
A subdural transducer-tipped catheter (CMS) can be used as the first-line equipment for monitoring ICP in patients with severe head injury. The clinical results are similar with other recent studies, but no complication such as infection or hemorrhage occurred in this study.
Hong
Wei-Chen
WC
Division of Neurosurgery, College of Medicine and Hospitals, National Taiwan University, Taipei, Taiwan.
Tu
Yong-Kwang
YK
Chen
Yuan-Shen
YS
Lien
Li-Ming
LM
Huang
Sheng-Jean
SJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D002404:Catheterization; D003422:Critical Care; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D012189:Retrospective Studies; D013355:Subdural Space; D014160:Transducers, Pressure; D016896:Treatment Outcome