Abstract | BACKGROUND: OBJECTIVE: To examine the pathophysiology of ICP in trauma, the management of polytrauma involving TBI, and the indications for decompressive craniectomy; and to compare the different monitoring systems and their complications. MATERIAL AND METHODS: A retrospective analysis of TBI patients between 2010 and 2016 was performed. Relevant publications are discussed, particularly those relating to the indications for monitoring and its influence on polytrauma management. RESULTS: Between 2010 and 2016, 106 patients with closed TBI and a mean age of 65.9 years received a total of 120 ICP monitors, most of which were parenchyma devices (111/120), followed by intraventricular catheters (8/120), and one combined system (1/120). Of these patients, 27.4% had sustained polytrauma, whilst 33% regularly used anticoagulants. ICP monitors were removed after 8.5 days on an average and the mean ICU stay was 20 days. Probe insertion was combined with craniectomy in 69.8% patients. Probe-related complications, most commonly involving malfunction, were seen in 6.6%. The duration of monitoring was significantly related to polytrauma (p ≤ 0.001) and age <60 (p = 0.03). ICU stay was also significantly related to polytrauma (p = 0.02) and monitoring complications (p ≤ 0.001). Mortality was related to anticoagulant medication (p = 0.01) and age <60 (p = 0.03). CONCLUSIONS: ICP monitoring is one of the most important tools in TBI treatment. The course and outcome of these severe injuries is affected by polytrauma, age, and the use of anticoagulants.
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Authors | T Neubauer, W Buchinger, E Höflinger, J Brand |
Journal | Der Unfallchirurg
(Unfallchirurg)
Vol. 120
Issue 9
Pg. 745-752
(Sep 2017)
ISSN: 1433-044X [Electronic] Germany |
Vernacular Title | Hirndruckmonitoring beim Polytraumatisierten mit Schädel-Hirn-Trauma. |
PMID | 28623468
(Publication Type: Journal Article, Review)
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Topics |
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Brain Injuries, Traumatic
(diagnosis, physiopathology, therapy)
- Cerebrovascular Circulation
(physiology)
- Craniotomy
- Critical Care
- Female
- Glasgow Coma Scale
- Humans
- Intracranial Pressure
(physiology)
- Male
- Middle Aged
- Monitoring, Physiologic
(instrumentation)
- Multiple Trauma
(diagnosis, physiopathology, therapy)
- Retrospective Studies
- Young Adult
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