title: Intracranial pressure monitoring after primary decompressive craniectomy in traumatic brain injury: a clinical study.
abstract: Intracranial pressure (ICP) monitoring represents an important tool in the management of traumatic brain injury (TBI). Although current information exists regarding ICP monitoring in secondary decompressive craniectomy (DC), little is known after primary DC following emergency hematoma evacuation.
  
  
  
  Retrospective analysis of prospectively collected data. Inclusion criteria were age ≥18 years and admission to the intensive care unit (ICU) for TBI and ICP monitoring after primary DC. Exclusion criteria were ICU length of stay (LOS) <1 day and pregnancy. Major objectives were: (1) to analyze changes in ICP/cerebral perfusion pressure (CPP) after primary DC, (2) to evaluate the relationship between ICP/CPP and neurological outcome and (3) to characterize and evaluate ICP-driven therapies after DC.
  
  
  
  A total of 34 patients were enrolled. Over 308 days of ICP/CPP monitoring, 130 days with at least one episode of intracranial hypertension (26 patients, 76.5%) and 57 days with at least one episode of CPP <60 mmHg (22 patients, 64.7%) were recorded. A statistically significant relationship was discovered between the Glasgow Outcome Scale (GOS) scores and mean post-decompression ICP (p < 0.04) and between GOS and CPP minimum (CPPmin) (p < 0.04). After DC, persisting intracranial hypertension was treated with: barbiturate coma (n = 7, 20.6%), external ventricular drain (EVD) (n = 4, 11.8%), DC diameter widening (n = 1, 2.9%) and removal of newly formed hematomas (n = 3, 8.8%).
  
  
  
  Intracranial hypertension and/or low CPP occurs frequently after primary DC; their occurence is associated with an unfavorable neurological outcome. ICP monitoring appears useful in guiding therapy after primary DC.
authors.affiliation: I Servizio Anestesia Rianimazione, Azienda Ospedaliero Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy. edoardopicetti@hotmail.com.
authors.forename: Edoardo
authors.identifier: 0000-0003-0316-1451
authors.initials: E
authors.lastname: Picetti
authors.affiliation: I Servizio Anestesia Rianimazione, Azienda Ospedaliero Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Caspani
authors.affiliation: Neurochirugia e Neurotraumatologia, Azienda Ospedaliero Universitaria di Parma and Arcispedale Santa Maria Nuova di Reggio Emilia, Parma and Reggio Emilia, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Iaccarino
authors.affiliation: Neurochirugia e Neurotraumatologia, Azienda Ospedaliero Universitaria di Parma and Arcispedale Santa Maria Nuova di Reggio Emilia, Parma and Reggio Emilia, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Pastorello
authors.affiliation: Servizio di Anestesia e Rianimazione, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Salsi
authors.affiliation: Neurochirugia e Neurotraumatologia, Azienda Ospedaliero Universitaria di Parma and Arcispedale Santa Maria Nuova di Reggio Emilia, Parma and Reggio Emilia, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Viaroli
authors.affiliation: Neurochirugia e Neurotraumatologia, Azienda Ospedaliero Universitaria di Parma and Arcispedale Santa Maria Nuova di Reggio Emilia, Parma and Reggio Emilia, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Servadei
mesh_terms: D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology* / Q000517:prevention & control; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control
keywords: Cerebral perfusion pressure; Intracranial pressure; Monitoring; Outcome; Primary decompressive craniectomy; Traumatic brain injury