Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

Chiara Robba; Francesca Graziano; Angelo Guglielmi; Paola Rebora; Stefania Galimberti; Fabio S. Taccone; Giuseppe Citerio; Walter Videtta; Gustavo Domeniconi; María Estrella Giménez; Mariela Fumale; Edgar Daniel Amundarain; Matias Casanova; Michael Reade; Elizabeth Hallt; David Pearson; Ian Seppelt; Raimund Helbok; Valery Davidovich; Geert Meyfroidt; Ilaria Alice Crippa; Liese Mebis; Patrick Biston; Stijn Van De Velde; Glorieux Denis; Pedro Kurtz; Samia Yasin Wayhs; Mypinder Sekhon; Donald Griesdale; Andrea Rigamonti; José Miguel Montes; Rodrigo Pérez-Araos; Jorge H. Mejia-Mantilla; Andrés Gempeler; Ray Mendoza; Natasa Kovac; Hedgar Berty Gutiérrez; Vera Spatenkova; Marek Fencl; Roman Gal; Ondrej Hrdy; Kamil Vrbica; Josef Skola; Eva Provaznikova; Jakub Kletecka; Pavel Lavicka; Vera Spatenkova; Piergiorgio Bresil; Marianne Levin; Piergiorgio Bresil; Josefine Thomsen; Thomas Egmose Larsen; Henrik Westy Hoffmeyer; Morten Olskjaer Holm; Jesper Borg Andersen; Birgitte Majholm; Margit Smitt; Heidi Shil Eddelien; Manuel Jibaja; Freddy Maldonado; María Fernanda García; Karim Asehnoune; Bertrand Pons; Gérard Audibert; Manon Lucca; Guillaume Besch; Pierluigi Banco; Karim Asehnoune; Raphael Cinotti; Hervé Quintard; Benjamin Soyer; Anais Caillard; Clement Gakuba; Romain Sonneville; Stefan Wolf; Kristina Fuest; Lea Albrecht; Sarah Grotheer; Sandro M. Krieg; Stefan J. Schaller; Charikleia Vrettou; Eftychia Kontoudaki; Anna Efthymiou; Elena Palli; Demosthenes Makris; Chrysi Diakaki; Christina Iasonidou; Aikaterini Dimoula; Georgios Koukoulitsios; George Kyriazopoulos; Nikolas Pantelas; Syragoula Tsikriki; Electra Eleni Stamou; Charikleia Vrettou; Achileas Giannopoulos; Eleni Mouloudi; Ping Shum Hoi; Yan Chan Cheuk; Hewa Kandamby Darshana; Krisztián Tánczos; Gabor Nardai; Zoltan Szentkereszty; Harsh Sapra; Deepak Gupta; Kaveri Sharma; Saurabh Anand; Ankur Luthra; Summit Bloria; Rajeev Chauhan; Nidhi Panda; Ahmad Ozair; Bram Kilapong; Anass Alsudani; Alessandra Soragni; Alessandro Motta; Andrea Marudi; Elisabetta Bertellini; Anselmo Caricato; Camilla Gelormini; Eleonora Ioannoni; Eleonora Stival; Serena Silva; Federico Pozzi; Iole Brunetti; Andrea Cortegiani; Edoardo Picetti; Federico Villa; Italo Calamai; Maria Chiara Casadio; Maria Concetta Quartarone; Marzia Grandis; Federico Magni; Silvia Del Bianco; Claudia Bonetti; Virginia Buldini; Aimone Giugni; Simone Maria Zerbi; Marco Carbonara; Antonella Cotoia; Antonio Izzi; Olegs Sabelnikovs; Muhammed Elhadi; Hazem Ahmed; Silvio A. Ñamendys Silva; Gilberto Adrian Gasca López; Gentle S. Shrestha; Shirish Maskey; Tamanna Bajracharya; Khadka Nilam; Prakash Kafle; Laleet Rajbanshi; Yam Bahadur Roka; Olufemi Idowu; Khan Muhammad Mukhtar; Juan Luis Pinedo Portilla; Klaudyna Kojder; Irene Aragao; Ricardo Freitas; Marco Simoes; Dario Batista; Cecília Pacheco; Fátima Assunção; Luís Lencastre; Pedro Cavaleiro; Mohamed Abdelaty; Alex Gritsan; Sergey Khomiakov Sergey; Dovbysh Nikolay; Yaseen Arabi; Primoz Gradisek; Petra Forjan; Mara Škoti; Suada Filekovic Ribaric; Primoz Gradisek; Nataša Milivojevic; Sergeja Kozar; Rafael Badenes; Aaron Blandino Ortiz; Mikel Celaya Lopez; Laura Galarza; Luisa Corral; Africa Lores; Ricard Soley; Laura Pariente; Pablo López Ojeda; Maria Dolores Arias Verdu; Luis Javier Yuste Dominguez; Maria Isabel Gonzalez Perez; Mireia Anglada; Patricia Duque; Ainhoa Serrano; Alessia Serrano; Berta Monleon; Vanessa Blazquez; Mauro Oddo; Samia Abed Maillard; Paola Morelli; John-Paul Miroz; Eva Favre; Walid Sellami; Massimo Lamperti; Jamil Dibu; Richard Sivities; Angelos Kolias; Chris Thompson; Christopher Hawthorne; Justin Roberts; Lara Prisco; Roger Lightfoot; Josè I. Suarez; Luci Rivera-Lara; Susanne Muehlschlegel; Juan Padilla; Sanjeev Sivakumar; Daiwai Olson

doi:10.1007/s00134-022-06937-1

Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

Chiara Robba, Francesca Graziano, Angelo Guglielmi, Paola Rebora, Stefania Galimberti, Fabio S. Taccone, Giuseppe Citerio, Walter Videtta, Gustavo Domeniconi, María Estrella Giménez, Mariela Fumale, Edgar Daniel Amundarain, Matias Casanova, Michael Reade, Elizabeth Hallt, David Pearson, Ian Seppelt, Raimund Helbok, Valery Davidovich, Geert MeyfroidtIlaria Alice Crippa, Liese Mebis, Patrick Biston, Stijn Van De Velde, Glorieux Denis, Pedro Kurtz, Samia Yasin Wayhs, Mypinder Sekhon, Donald Griesdale, Andrea Rigamonti, José Miguel Montes, Rodrigo Pérez-Araos, Jorge H. Mejia-Mantilla, Andrés Gempeler, Ray Mendoza, Natasa Kovac, Hedgar Berty Gutiérrez, Vera Spatenkova, Marek Fencl, Roman Gal, Ondrej Hrdy, Kamil Vrbica, Josef Skola, Eva Provaznikova, Jakub Kletecka, Pavel Lavicka, Vera Spatenkova, Piergiorgio Bresil, Marianne Levin, Piergiorgio Bresil, Josefine Thomsen, Thomas Egmose Larsen, Henrik Westy Hoffmeyer, Morten Olskjaer Holm, Jesper Borg Andersen, Birgitte Majholm, Margit Smitt, Heidi Shil Eddelien, Manuel Jibaja, Freddy Maldonado, María Fernanda García, Karim Asehnoune, Bertrand Pons, Gérard Audibert, Manon Lucca, Guillaume Besch, Pierluigi Banco, Karim Asehnoune, Raphael Cinotti, Hervé Quintard, Benjamin Soyer, Anais Caillard, Clement Gakuba, Romain Sonneville, Stefan Wolf, Kristina Fuest, Lea Albrecht, Sarah Grotheer, Sandro M. Krieg, Stefan J. Schaller, Charikleia Vrettou, Eftychia Kontoudaki, Anna Efthymiou, Elena Palli, Demosthenes Makris, Chrysi Diakaki, Christina Iasonidou, Aikaterini Dimoula, Georgios Koukoulitsios, George Kyriazopoulos, Nikolas Pantelas, Syragoula Tsikriki, Electra Eleni Stamou, Charikleia Vrettou, Achileas Giannopoulos, Eleni Mouloudi, Ping Shum Hoi, Yan Chan Cheuk, Hewa Kandamby Darshana, Krisztián Tánczos, Gabor Nardai, Zoltan Szentkereszty, Harsh Sapra, Deepak Gupta, Kaveri Sharma, Saurabh Anand, Ankur Luthra, Summit Bloria, Rajeev Chauhan, Nidhi Panda, Ahmad Ozair, Bram Kilapong, Anass Alsudani, Alessandra Soragni, Alessandro Motta, Andrea Marudi, Elisabetta Bertellini, Anselmo Caricato, Camilla Gelormini, Eleonora Ioannoni, Eleonora Stival, Serena Silva, Federico Pozzi, Iole Brunetti, Andrea Cortegiani, Edoardo Picetti, Federico Villa, Italo Calamai, Maria Chiara Casadio, Maria Concetta Quartarone, Marzia Grandis, Federico Magni, Silvia Del Bianco, Claudia Bonetti, Virginia Buldini, Aimone Giugni, Simone Maria Zerbi, Marco Carbonara, Antonella Cotoia, Antonio Izzi, Olegs Sabelnikovs, Muhammed Elhadi, Hazem Ahmed, Silvio A. Ñamendys Silva, Gilberto Adrian Gasca López, Gentle S. Shrestha, Shirish Maskey, Tamanna Bajracharya, Khadka Nilam, Prakash Kafle, Laleet Rajbanshi, Yam Bahadur Roka, Olufemi Idowu, Khan Muhammad Mukhtar, Juan Luis Pinedo Portilla, Klaudyna Kojder, Irene Aragao, Ricardo Freitas, Marco Simoes, Dario Batista, Cecília Pacheco, Fátima Assunção, Luís Lencastre, Pedro Cavaleiro, Mohamed Abdelaty, Alex Gritsan, Sergey Khomiakov Sergey, Dovbysh Nikolay, Yaseen Arabi, Primoz Gradisek, Petra Forjan, Mara Škoti, Suada Filekovic Ribaric, Primoz Gradisek, Nataša Milivojevic, Sergeja Kozar, Rafael Badenes, Aaron Blandino Ortiz, Mikel Celaya Lopez, Laura Galarza, Luisa Corral, Africa Lores, Ricard Soley, Laura Pariente, Pablo López Ojeda, Maria Dolores Arias Verdu, Luis Javier Yuste Dominguez, Maria Isabel Gonzalez Perez, Mireia Anglada, Patricia Duque, Ainhoa Serrano, Alessia Serrano, Berta Monleon, Vanessa Blazquez, Mauro Oddo, Samia Abed Maillard, Paola Morelli, John-Paul Miroz, Eva Favre, Walid Sellami, Massimo Lamperti, Jamil Dibu, Richard Sivities, Angelos Kolias, Chris Thompson, Christopher Hawthorne, Justin Roberts, Lara Prisco, Roger Lightfoot, Josè I. Suarez, Luci Rivera-Lara, Susanne Muehlschlegel, Juan Padilla, Sanjeev Sivakumar, Daiwai Olson

Risultato della ricerca: Contributo in rivista › Articolo in rivista

Abstract

Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39–69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I–III quartiles = 35–62) vs 56 (40–69) years, p < 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p < 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p < 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p < 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR = 1.612, 95% Confidence Interval, CI = 1.243–2.091, p < 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR = 1.017, 95% CI = 0.823–1.257, p = 0.873). No significant association between the use of TIL and neurological outcome was observed. Conclusions: During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome.

Lingua originale	English
pagine (da-a)	50-61
Numero di pagine	12
Rivista	Intensive Care Medicine
Volume	49
DOI	https://doi.org/10.1007/s00134-022-06937-1
Stato di pubblicazione	Pubblicato - 2023

Keywords

Intracranial haemorrhage
Intracranial pressure
Subarachnoid haemorrhage
Therapy intensity level
Traumatic brain injury

Accesso al documento

10.1007/s00134-022-06937-1

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Robba, C., Graziano, F., Guglielmi, A., Rebora, P., Galimberti, S., Taccone, F. S., Citerio, G., Videtta, W., Domeniconi, G., Giménez, M. E., Fumale, M., Amundarain, E. D., Casanova, M., Reade, M., Hallt, E., Pearson, D., Seppelt, I., Helbok, R., Davidovich, V., ... Olson, D. (2023). Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study. Intensive Care Medicine, 49, 50-61. https://doi.org/10.1007/s00134-022-06937-1

@article{836f26cb11cc46df8cc5cdf9d8ad1d2d,

title = "Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study",

abstract = "Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39–69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I–III quartiles = 35–62) vs 56 (40–69) years, p < 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p < 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p < 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p < 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR = 1.612, 95% Confidence Interval, CI = 1.243–2.091, p < 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR = 1.017, 95% CI = 0.823–1.257, p = 0.873). No significant association between the use of TIL and neurological outcome was observed. Conclusions: During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome.",

keywords = "Intracranial haemorrhage, Intracranial pressure, Subarachnoid haemorrhage, Therapy intensity level, Traumatic brain injury, Intracranial haemorrhage, Intracranial pressure, Subarachnoid haemorrhage, Therapy intensity level, Traumatic brain injury",

author = "Chiara Robba and Francesca Graziano and Angelo Guglielmi and Paola Rebora and Stefania Galimberti and Taccone, {Fabio S.} and Giuseppe Citerio and Walter Videtta and Gustavo Domeniconi and Gim{\'e}nez, {Mar{\'i}a Estrella} and Mariela Fumale and Amundarain, {Edgar Daniel} and Matias Casanova and Michael Reade and Elizabeth Hallt and David Pearson and Ian Seppelt and Raimund Helbok and Valery Davidovich and Geert Meyfroidt and Crippa, {Ilaria Alice} and Liese Mebis and Patrick Biston and {Van De Velde}, Stijn and Glorieux Denis and Pedro Kurtz and Wayhs, {Samia Yasin} and Mypinder Sekhon and Donald Griesdale and Andrea Rigamonti and Montes, {Jos{\'e} Miguel} and Rodrigo P{\'e}rez-Araos and Mejia-Mantilla, {Jorge H.} and Andr{\'e}s Gempeler and Ray Mendoza and Natasa Kovac and Guti{\'e}rrez, {Hedgar Berty} and Vera Spatenkova and Marek Fencl and Roman Gal and Ondrej Hrdy and Kamil Vrbica and Josef Skola and Eva Provaznikova and Jakub Kletecka and Pavel Lavicka and Vera Spatenkova and Piergiorgio Bresil and Marianne Levin and Piergiorgio Bresil and Josefine Thomsen and Larsen, {Thomas Egmose} and Hoffmeyer, {Henrik Westy} and Holm, {Morten Olskjaer} and Andersen, {Jesper Borg} and Birgitte Majholm and Margit Smitt and Eddelien, {Heidi Shil} and Manuel Jibaja and Freddy Maldonado and Garc{\'i}a, {Mar{\'i}a Fernanda} and Karim Asehnoune and Bertrand Pons and G{\'e}rard Audibert and Manon Lucca and Guillaume Besch and Pierluigi Banco and Karim Asehnoune and Raphael Cinotti and Herv{\'e} Quintard and Benjamin Soyer and Anais Caillard and Clement Gakuba and Romain Sonneville and Stefan Wolf and Kristina Fuest and Lea Albrecht and Sarah Grotheer and Krieg, {Sandro M.} and Schaller, {Stefan J.} and Charikleia Vrettou and Eftychia Kontoudaki and Anna Efthymiou and Elena Palli and Demosthenes Makris and Chrysi Diakaki and Christina Iasonidou and Aikaterini Dimoula and Georgios Koukoulitsios and George Kyriazopoulos and Nikolas Pantelas and Syragoula Tsikriki and Stamou, {Electra Eleni} and Charikleia Vrettou and Achileas Giannopoulos and Eleni Mouloudi and Hoi, {Ping Shum} and Cheuk, {Yan Chan} and Darshana, {Hewa Kandamby} and Kriszti{\'a}n T{\'a}nczos and Gabor Nardai and Zoltan Szentkereszty and Harsh Sapra and Deepak Gupta and Kaveri Sharma and Saurabh Anand and Ankur Luthra and Summit Bloria and Rajeev Chauhan and Nidhi Panda and Ahmad Ozair and Bram Kilapong and Anass Alsudani and Alessandra Soragni and Alessandro Motta and Andrea Marudi and Elisabetta Bertellini and Anselmo Caricato and Camilla Gelormini and Eleonora Ioannoni and Eleonora Stival and Serena Silva and Federico Pozzi and Iole Brunetti and Andrea Cortegiani and Edoardo Picetti and Federico Villa and Italo Calamai and Casadio, {Maria Chiara} and Quartarone, {Maria Concetta} and Marzia Grandis and Federico Magni and Bianco, {Silvia Del} and Claudia Bonetti and Virginia Buldini and Aimone Giugni and Zerbi, {Simone Maria} and Marco Carbonara and Antonella Cotoia and Antonio Izzi and Olegs Sabelnikovs and Muhammed Elhadi and Hazem Ahmed and Silva, {Silvio A. {\~N}amendys} and L{\'o}pez, {Gilberto Adrian Gasca} and Shrestha, {Gentle S.} and Shirish Maskey and Tamanna Bajracharya and Khadka Nilam and Prakash Kafle and Laleet Rajbanshi and Roka, {Yam Bahadur} and Olufemi Idowu and Mukhtar, {Khan Muhammad} and Portilla, {Juan Luis Pinedo} and Klaudyna Kojder and Irene Aragao and Ricardo Freitas and Marco Simoes and Dario Batista and Cec{\'i}lia Pacheco and F{\'a}tima Assun{\c c}{\~a}o and Lu{\'i}s Lencastre and Pedro Cavaleiro and Mohamed Abdelaty and Alex Gritsan and Sergey, {Sergey Khomiakov} and Dovbysh Nikolay and Yaseen Arabi and Primoz Gradisek and Petra Forjan and Mara {\v S}koti and Ribaric, {Suada Filekovic} and Primoz Gradisek and Nata{\v s}a Milivojevic and Sergeja Kozar and Rafael Badenes and Ortiz, {Aaron Blandino} and Lopez, {Mikel Celaya} and Laura Galarza and Luisa Corral and Africa Lores and Ricard Soley and Laura Pariente and Ojeda, {Pablo L{\'o}pez} and Verdu, {Maria Dolores Arias} and Dominguez, {Luis Javier Yuste} and Perez, {Maria Isabel Gonzalez} and Mireia Anglada and Patricia Duque and Ainhoa Serrano and Alessia Serrano and Berta Monleon and Vanessa Blazquez and Mauro Oddo and Maillard, {Samia Abed} and Paola Morelli and John-Paul Miroz and Eva Favre and Walid Sellami and Massimo Lamperti and Jamil Dibu and Richard Sivities and Angelos Kolias and Chris Thompson and Christopher Hawthorne and Justin Roberts and Lara Prisco and Roger Lightfoot and Suarez, {Jos{\`e} I.} and Luci Rivera-Lara and Susanne Muehlschlegel and Juan Padilla and Sanjeev Sivakumar and Daiwai Olson",

year = "2023",

doi = "10.1007/s00134-022-06937-1",

language = "English",

volume = "49",

pages = "50--61",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer Science and Business Media Deutschland GmbH",

}

Robba, C, Graziano, F, Guglielmi, A, Rebora, P, Galimberti, S, Taccone, FS, Citerio, G, Videtta, W, Domeniconi, G, Giménez, ME, Fumale, M, Amundarain, ED, Casanova, M, Reade, M, Hallt, E, Pearson, D, Seppelt, I, Helbok, R, Davidovich, V, Meyfroidt, G, Crippa, IA, Mebis, L, Biston, P, Van De Velde, S, Denis, G, Kurtz, P, Wayhs, SY, Sekhon, M, Griesdale, D, Rigamonti, A, Montes, JM, Pérez-Araos, R, Mejia-Mantilla, JH, Gempeler, A, Mendoza, R, Kovac, N, Gutiérrez, HB, Spatenkova, V, Fencl, M, Gal, R, Hrdy, O, Vrbica, K, Skola, J, Provaznikova, E, Kletecka, J, Lavicka, P, Spatenkova, V, Bresil, P, Levin, M, Bresil, P, Thomsen, J, Larsen, TE, Hoffmeyer, HW, Holm, MO, Andersen, JB, Majholm, B, Smitt, M, Eddelien, HS, Jibaja, M, Maldonado, F, García, MF, Asehnoune, K, Pons, B, Audibert, G, Lucca, M, Besch, G, Banco, P, Asehnoune, K, Cinotti, R, Quintard, H, Soyer, B, Caillard, A, Gakuba, C, Sonneville, R, Wolf, S, Fuest, K, Albrecht, L, Grotheer, S, Krieg, SM, Schaller, SJ, Vrettou, C, Kontoudaki, E, Efthymiou, A, Palli, E, Makris, D, Diakaki, C, Iasonidou, C, Dimoula, A, Koukoulitsios, G, Kyriazopoulos, G, Pantelas, N, Tsikriki, S, Stamou, EE, Vrettou, C, Giannopoulos, A, Mouloudi, E, Hoi, PS, Cheuk, YC, Darshana, HK, Tánczos, K, Nardai, G, Szentkereszty, Z, Sapra, H, Gupta, D, Sharma, K, Anand, S, Luthra, A, Bloria, S, Chauhan, R, Panda, N, Ozair, A, Kilapong, B, Alsudani, A, Soragni, A, Motta, A, Marudi, A, Bertellini, E, Caricato, A, Gelormini, C, Ioannoni, E, Stival, E, Silva, S, Pozzi, F, Brunetti, I, Cortegiani, A, Picetti, E, Villa, F, Calamai, I, Casadio, MC, Quartarone, MC, Grandis, M, Magni, F, Bianco, SD, Bonetti, C, Buldini, V, Giugni, A, Zerbi, SM, Carbonara, M, Cotoia, A, Izzi, A, Sabelnikovs, O, Elhadi, M, Ahmed, H, Silva, SAÑ, López, GAG, Shrestha, GS, Maskey, S, Bajracharya, T, Nilam, K, Kafle, P, Rajbanshi, L, Roka, YB, Idowu, O, Mukhtar, KM, Portilla, JLP, Kojder, K, Aragao, I, Freitas, R, Simoes, M, Batista, D, Pacheco, C, Assunção, F, Lencastre, L, Cavaleiro, P, Abdelaty, M, Gritsan, A, Sergey, SK, Nikolay, D, Arabi, Y, Gradisek, P, Forjan, P, Škoti, M, Ribaric, SF, Gradisek, P, Milivojevic, N, Kozar, S, Badenes, R, Ortiz, AB, Lopez, MC, Galarza, L, Corral, L, Lores, A, Soley, R, Pariente, L, Ojeda, PL, Verdu, MDA, Dominguez, LJY, Perez, MIG, Anglada, M, Duque, P, Serrano, A, Serrano, A, Monleon, B, Blazquez, V, Oddo, M, Maillard, SA, Morelli, P, Miroz, J-P, Favre, E, Sellami, W, Lamperti, M, Dibu, J, Sivities, R, Kolias, A, Thompson, C, Hawthorne, C, Roberts, J, Prisco, L, Lightfoot, R, Suarez, JI, Rivera-Lara, L, Muehlschlegel, S, Padilla, J, Sivakumar, S & Olson, D 2023, 'Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study', Intensive Care Medicine, vol. 49, pagg. 50-61. https://doi.org/10.1007/s00134-022-06937-1

TY - JOUR

T1 - Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

AU - Robba, Chiara

AU - Graziano, Francesca

AU - Guglielmi, Angelo

AU - Rebora, Paola

AU - Galimberti, Stefania

AU - Taccone, Fabio S.

AU - Citerio, Giuseppe

AU - Videtta, Walter

AU - Domeniconi, Gustavo

AU - Giménez, María Estrella

AU - Fumale, Mariela

AU - Amundarain, Edgar Daniel

AU - Casanova, Matias

AU - Reade, Michael

AU - Hallt, Elizabeth

AU - Pearson, David

AU - Seppelt, Ian

AU - Helbok, Raimund

AU - Davidovich, Valery

AU - Meyfroidt, Geert

AU - Crippa, Ilaria Alice

AU - Mebis, Liese

AU - Biston, Patrick

AU - Van De Velde, Stijn

AU - Denis, Glorieux

AU - Kurtz, Pedro

AU - Wayhs, Samia Yasin

AU - Sekhon, Mypinder

AU - Griesdale, Donald

AU - Rigamonti, Andrea

AU - Montes, José Miguel

AU - Pérez-Araos, Rodrigo

AU - Mejia-Mantilla, Jorge H.

AU - Gempeler, Andrés

AU - Mendoza, Ray

AU - Kovac, Natasa

AU - Gutiérrez, Hedgar Berty

AU - Spatenkova, Vera

AU - Fencl, Marek

AU - Gal, Roman

AU - Hrdy, Ondrej

AU - Vrbica, Kamil

AU - Skola, Josef

AU - Provaznikova, Eva

AU - Kletecka, Jakub

AU - Lavicka, Pavel

AU - Spatenkova, Vera

AU - Bresil, Piergiorgio

AU - Levin, Marianne

AU - Bresil, Piergiorgio

AU - Thomsen, Josefine

AU - Larsen, Thomas Egmose

AU - Hoffmeyer, Henrik Westy

AU - Holm, Morten Olskjaer

AU - Andersen, Jesper Borg

AU - Majholm, Birgitte

AU - Smitt, Margit

AU - Eddelien, Heidi Shil

AU - Jibaja, Manuel

AU - Maldonado, Freddy

AU - García, María Fernanda

AU - Asehnoune, Karim

AU - Pons, Bertrand

AU - Audibert, Gérard

AU - Lucca, Manon

AU - Besch, Guillaume

AU - Banco, Pierluigi

AU - Asehnoune, Karim

AU - Cinotti, Raphael

AU - Quintard, Hervé

AU - Soyer, Benjamin

AU - Caillard, Anais

AU - Gakuba, Clement

AU - Sonneville, Romain

AU - Wolf, Stefan

AU - Fuest, Kristina

AU - Albrecht, Lea

AU - Grotheer, Sarah

AU - Krieg, Sandro M.

AU - Schaller, Stefan J.

AU - Vrettou, Charikleia

AU - Kontoudaki, Eftychia

AU - Efthymiou, Anna

AU - Palli, Elena

AU - Makris, Demosthenes

AU - Diakaki, Chrysi

AU - Iasonidou, Christina

AU - Dimoula, Aikaterini

AU - Koukoulitsios, Georgios

AU - Kyriazopoulos, George

AU - Pantelas, Nikolas

AU - Tsikriki, Syragoula

AU - Stamou, Electra Eleni

AU - Vrettou, Charikleia

AU - Giannopoulos, Achileas

AU - Mouloudi, Eleni

AU - Hoi, Ping Shum

AU - Cheuk, Yan Chan

AU - Darshana, Hewa Kandamby

AU - Tánczos, Krisztián

AU - Nardai, Gabor

AU - Szentkereszty, Zoltan

AU - Sapra, Harsh

AU - Gupta, Deepak

AU - Sharma, Kaveri

AU - Anand, Saurabh

AU - Luthra, Ankur

AU - Bloria, Summit

AU - Chauhan, Rajeev

AU - Panda, Nidhi

AU - Ozair, Ahmad

AU - Kilapong, Bram

AU - Alsudani, Anass

AU - Soragni, Alessandra

AU - Motta, Alessandro

AU - Marudi, Andrea

AU - Bertellini, Elisabetta

AU - Caricato, Anselmo

AU - Gelormini, Camilla

AU - Ioannoni, Eleonora

AU - Stival, Eleonora

AU - Silva, Serena

AU - Pozzi, Federico

AU - Brunetti, Iole

AU - Cortegiani, Andrea

AU - Picetti, Edoardo

AU - Villa, Federico

AU - Calamai, Italo

AU - Casadio, Maria Chiara

AU - Quartarone, Maria Concetta

AU - Grandis, Marzia

AU - Magni, Federico

AU - Bianco, Silvia Del

AU - Bonetti, Claudia

AU - Buldini, Virginia

AU - Giugni, Aimone

AU - Zerbi, Simone Maria

AU - Carbonara, Marco

AU - Cotoia, Antonella

AU - Izzi, Antonio

AU - Sabelnikovs, Olegs

AU - Elhadi, Muhammed

AU - Ahmed, Hazem

AU - Silva, Silvio A. Ñamendys

AU - López, Gilberto Adrian Gasca

AU - Shrestha, Gentle S.

AU - Maskey, Shirish

AU - Bajracharya, Tamanna

AU - Nilam, Khadka

AU - Kafle, Prakash

AU - Rajbanshi, Laleet

AU - Roka, Yam Bahadur

AU - Idowu, Olufemi

AU - Mukhtar, Khan Muhammad

AU - Portilla, Juan Luis Pinedo

AU - Kojder, Klaudyna

AU - Aragao, Irene

AU - Freitas, Ricardo

AU - Simoes, Marco

AU - Batista, Dario

AU - Pacheco, Cecília

AU - Assunção, Fátima

AU - Lencastre, Luís

AU - Cavaleiro, Pedro

AU - Abdelaty, Mohamed

AU - Gritsan, Alex

AU - Sergey, Sergey Khomiakov

AU - Nikolay, Dovbysh

AU - Arabi, Yaseen

AU - Gradisek, Primoz

AU - Forjan, Petra

AU - Škoti, Mara

AU - Ribaric, Suada Filekovic

AU - Gradisek, Primoz

AU - Milivojevic, Nataša

AU - Kozar, Sergeja

AU - Badenes, Rafael

AU - Ortiz, Aaron Blandino

AU - Lopez, Mikel Celaya

AU - Galarza, Laura

AU - Corral, Luisa

AU - Lores, Africa

AU - Soley, Ricard

AU - Pariente, Laura

AU - Ojeda, Pablo López

AU - Verdu, Maria Dolores Arias

AU - Dominguez, Luis Javier Yuste

AU - Perez, Maria Isabel Gonzalez

AU - Anglada, Mireia

AU - Duque, Patricia

AU - Serrano, Ainhoa

AU - Serrano, Alessia

AU - Monleon, Berta

AU - Blazquez, Vanessa

AU - Oddo, Mauro

AU - Maillard, Samia Abed

AU - Morelli, Paola

AU - Miroz, John-Paul

AU - Favre, Eva

AU - Sellami, Walid

AU - Lamperti, Massimo

AU - Dibu, Jamil

AU - Sivities, Richard

AU - Kolias, Angelos

AU - Thompson, Chris

AU - Hawthorne, Christopher

AU - Roberts, Justin

AU - Prisco, Lara

AU - Lightfoot, Roger

AU - Suarez, Josè I.

AU - Rivera-Lara, Luci

AU - Muehlschlegel, Susanne

AU - Padilla, Juan

AU - Sivakumar, Sanjeev

AU - Olson, Daiwai

PY - 2023

Y1 - 2023

N2 - Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39–69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I–III quartiles = 35–62) vs 56 (40–69) years, p < 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p < 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p < 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p < 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR = 1.612, 95% Confidence Interval, CI = 1.243–2.091, p < 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR = 1.017, 95% CI = 0.823–1.257, p = 0.873). No significant association between the use of TIL and neurological outcome was observed. Conclusions: During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome.

AB - Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39–69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I–III quartiles = 35–62) vs 56 (40–69) years, p < 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p < 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p < 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p < 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR = 1.612, 95% Confidence Interval, CI = 1.243–2.091, p < 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR = 1.017, 95% CI = 0.823–1.257, p = 0.873). No significant association between the use of TIL and neurological outcome was observed. Conclusions: During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome.

KW - Intracranial haemorrhage

KW - Intracranial pressure

KW - Subarachnoid haemorrhage

KW - Therapy intensity level

KW - Traumatic brain injury

KW - Intracranial haemorrhage

KW - Intracranial pressure

KW - Subarachnoid haemorrhage

KW - Therapy intensity level

KW - Traumatic brain injury

UR - http://hdl.handle.net/10807/304353

U2 - 10.1007/s00134-022-06937-1

DO - 10.1007/s00134-022-06937-1

M3 - Article

SN - 0342-4642

VL - 49

SP - 50

EP - 61

JO - Intensive Care Medicine

JF - Intensive Care Medicine

ER -

Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

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