title: Burst Suppression for ICP Control.
abstract: BACKGROUND
  The goal of our study was to perform a systematic review of the literature to determine the effect that burst suppression has on intracranial pressure (ICP) control.
  
  
  METHODS
  All articles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to January 2015), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and the Grading of Recommendation Assessment Development and Education (GRADE) methodology.
  
  
  RESULTS
  Seven articles were considered for review. A total of 108 patients were studied, all receiving burst suppression therapy. Two studies failed to document a decrease in ICP with burst suppression therapy. There were reports of severe hypotension and increased infection rates with barbiturate-based therapy. Etomidate-based suppressive therapy was linked to severe renal dysfunction.
  
  
  CONCLUSIONS
  There currently exists both Oxford level 2b and GRADE C evidence to support that achieving burst suppression reduces ICP, and also has no effect on ICP, in severe traumatic brain injury. The literature suggests burst suppression therapy may be useful for ICP reduction in certain cases, although these situations are currently unclear. In addition, the impact on patient functional outcome is unclear. Further prospective study is warranted.
authors.affiliation: 1 Department of Surgery, Section of Neurosurgery, University of Manitoba, Winnipeg, Canada.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Zeiler
authors.affiliation: 1 Department of Surgery, Section of Neurosurgery, University of Manitoba, Winnipeg, Canada.
authors.forename: Eva
authors.initials: E
authors.lastname: Akoth
authors.affiliation: 2 Department of Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, Canada.|3 Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Canada.
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Gillman
authors.affiliation: 1 Department of Surgery, Section of Neurosurgery, University of Manitoba, Winnipeg, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: West
mesh_terms: D000777:Anesthetics / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D004562:Electrocardiography; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects*; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D056888:Patient Positioning; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
chemical_list: D000777:Anesthetics; D018696:Neuroprotective Agents
keywords: ICP; burst suppression; intracranial pressure