Intracranial pressure and outcome in critically ill patients with aneurysmal subarachnoid hemorrhage: a systematic review.

Details

Serval ID
serval:BIB_AC555878CA48
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Intracranial pressure and outcome in critically ill patients with aneurysmal subarachnoid hemorrhage: a systematic review.
Journal
Minerva anestesiologica
Author(s)
Cossu G., Messerer M., Stocchetti N., Levivier M., Daniel R.T., Oddo M.
ISSN
1827-1596 (Electronic)
ISSN-L
0375-9393
Publication state
Published
Issued date
06/2016
Peer-reviewed
Oui
Volume
82
Number
6
Pages
684-696
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Abstract
Evidences supporting the use of intracranial pressure (ICP) monitoring after aneurysmal subarachnoid hemorrhage (aSAH) are limited. The aim of our paper was to examine whether elevated intracranial pressure and ICP-derived variables predict mortality and functional outcomes after aSAH.
A systematic review of the literature was performed through PubMed and Cochrane databases up to June 2015. Population was restricted to aSAH patients requiring admission to the intensive care unit. ICP was included in the analysis as absolute value as well as variables derived from ICP monitoring (pressure reactivity index, ICP pulse wave amplitude, ICP-arterial blood pressure wave amplitude correlation and ICP variability). Outcomes included mortality, neurological recovery and delayed cerebral ischemia (DCI). Quality of evidence was rated using the GRADE system.
Twenty-six studies were examined. Due to heterogeneity in qualifying studies, a meta-analysis could not be generated. We found a correlation between elevated ICP and mortality. However, ICP absolute values were not independent predictors of long-term functional outcomes (low quality of evidence). A variable relationship between elevated ICP and DCI was found (very low quality of evidence). ICP-derived variables had higher accuracy than ICP absolute values in predicting functional outcomes (moderate quality of evidence).
Elevated ICP was associated with higher mortality however absolute ICP values per se were not independent predictors of functional recovery. Variables derived from ICP monitoring are more accurate than ICP absolute values in predicting outcome. Given the absence of good quality data, additional large studies may help to better define the prognostic value of ICP after aSAH.
Keywords
Brain Ischemia/etiology, Critical Illness, Humans, Intracranial Aneurysm/complications, Intracranial Hypertension/complications, Intracranial Hypertension/mortality, Intracranial Pressure, Subarachnoid Hemorrhage/etiology, Subarachnoid Hemorrhage/mortality
Pubmed
Web of science
Create date
23/12/2016 13:47
Last modification date
27/03/2020 6:19
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