title: A randomized and blinded single-center trial comparing the effect of intracranial pressure and intracranial pressure wave amplitude-guided intensive care management on early clinical state and 12-month outcome in patients with aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  In patients with aneurysmal subarachnoid hemorrhage (SAH), preliminary results indicate that the amplitude of the single intracranial pressure (ICP) wave is a better predictor of the early clinical state and 6-month outcome than the mean ICP.
  
  
  OBJECTIVE
  To perform a randomized and blinded single-center trial comparing the effect of mean ICP vs mean ICP wave amplitude (MWA)-guided intensive care management on early clinical state and outcome in patients with aneurysmal SAH.
  
  
  METHODS
  Patients were randomized to 2 different types of ICP management: maintenance of mean ICP less than 20 mm Hg and MWA less than 5 mm Hg. Early clinical state was assessed daily using the Glasgow Coma Scale. The primary efficacy variable was 12-month outcome in terms of the Rankin Stroke Score.
  
  
  RESULTS
  Ninety-seven patients were included in the study. There were no significant differences in treatment between the 2 groups apart from a larger volume of cerebrospinal fluid drained during week 1 in the MWA group. There was a tendency toward higher Glasgow Coma Scale scores in the MWA group during weeks 1 (P = .08) and 2 (P = .07). Outcome in terms of Rankin Stroke Score at 12 months was significantly better in the MWA group (P < .05).
  
  
  CONCLUSIONS
  This randomized and blinded trial disclosed a significant better primary efficacy variable (Rankin Stroke Score after 12 months) in the MWA patient group. We suggest that proactive intensive care management with MWA-tailored cerebrospinal fluid drainage during the first week improves aneurysmal SAH outcome.
authors.affiliation: Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway. per.kristian.eide@ous-hf.no
authors.forename: Per Kristian
authors.initials: PK
authors.lastname: Eide
authors.forename: Gunnar
authors.initials: G
authors.lastname: Bentsen
authors.forename: Angelika G
authors.initials: AG
authors.lastname: Sorteberg
authors.forename: Pål Bache
authors.initials: PB
authors.lastname: Marthinsen
authors.forename: Audun
authors.initials: A
authors.lastname: Stubhaug
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Sorteberg
mesh_terms: D000328:Adult; D000368:Aged; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D002557:Cerebrospinal Fluid Shunts / Q000379:methods; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000188:drug therapy* / Q000601:surgery*; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D016037:Single-Blind Method; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome