Patterns of increased intracranial pressure after severe traumatic brain injury.
BACKGROUND
Secondary brain injury due to increased intracranial pressure (ICP) contributes to post-traumatic morbidity and mortality. Although it is often taught that increased ICP begins early after traumatic brain injury, some patients develop increased ICP after the first 3 days post-injury. We examined our data to describe temporal patterns of increased ICP.


METHODS
This is a retrospective review of prospectively collected physiologic and demographic data.


RESULTS
Seventy-seven patients were included. We identified four patterns of increased ICP: beginning within 72 h (early), beginning after 72 h (late), early increases with resolution, and then a second rise after 72 h (bimodal), and continuously increased ICP. Late increases in ICP occur in 17% of this cohort. Peak day of swelling was day 7 for the "late" rise group and day 4 for the other patients with increased ICP. Forty-four percent of patients showed enlargement of cerebral contusions on follow-up imaging at 24 h post-injury.


CONCLUSIONS
Late rises in ICP were not rare in this cohort. This is clinically relevant as it may impact decisions about ICP monitor removal. Differences between groups in age, CT patterns of injury, fluid therapy, osmotic use, and fever were not statistically significant.
O'Phelan
Kristine H
KH
Neuroscience Institute, Queen's Medical Center, Honolulu, HI 96813, USA. kophelan@med.miami.edu.
Park
Dalnam
D
Efird
Jimmy T
JT
Johnson
Katherine
K
Albano
Melanie
M
Beniga
Juliet
J
Green
Deborah M
DM
Chang
Cherylee W J
CW
D000328:Adult; D001929:Brain Edema / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D001930:Brain Injuries / Q000150:complications* / Q000503:physiopathology* / Q000628:therapy; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology* / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult