What Do We Do When the ICP Goes Up?
Abstract
BACKGROUND/OBJECTIVE: We sought to study which intracranial pressure (ICP)-lowering treatments are actually administered following the diagnosis of a clinical intracranial hypertension episode (CLICHÉ) during modern, routine care.
METHODS: We performed a secondary analysis of data from patients with ICP only (normal or blinded partial pressure of brain tissue oxygen [PbtO2]) in the Brain Tissue Oxygen Monitoring and Management in Severe Traumatic Brain Injury (BOOST II) randomized trial. We identified "minimalist" (forme fruste) CLICHÉs (defined by 5 min of ICP > 20 lasting ≤ 60 min, requiring only Tier One treatments) and catalogued all interventions by frequency, grouping and distribution of administration. Tier One treatments were not rank-ordered.
RESULTS: Of the 119 randomized patients, 70 had 509 CLICHÉs that met forme fruste definition with complete datasets (71% of total CLICHÉs). Analgosedation adjustment and cerebrospinal fluid (CSF) drainage were the predominant treatments, used respectively in 72% and 33% of full CLICHÉs and within the first 15 min in 53% and 31%. In combination, they were the third most common intervention. Treatments often involved agent combinations (41% for full CLICHÉs; 46% within the first 15 min). Treatments that could be readily and discretionally administered by the bedside clinician represented 76% of treatments for full CLICHÉs and 69% for early interventions.
CONCLUSIONS: Analgosedation adjustment predominates as the treatment of…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 119 participants or records.
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