gms | German Medical Science

66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Friendship Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

7. - 10. Juni 2015, Karlsruhe

Reconsidering commonly tolerated postsurgical ICP-values in patients undergoing decompressive craniectomy

Meeting Abstract

  • Thomas Sauvigny - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Jennifer Göttsche - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Friederike Fritzsche - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Patrick Czorlich - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Manfred Westphal - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Jan Regelsberger - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocDI.12.04

doi: 10.3205/15dgnc154, urn:nbn:de:0183-15dgnc1548

Veröffentlicht: 2. Juni 2015

© 2015 Sauvigny et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Decompressive craniectomy (DC) is a well-established ultima ratio therapy in the management of patients with increased intracranial pressure (ICP). Yet, recordings of intracranial pressure in this subgroup of patients are not sufficiently correlated with clinical outcome. Therefore we analyzed ICP values, clinical parameters and outcome scores.

Method: We analyzed intracranial pressure over a period of the first 168 hours after DC in 102 patients of whom 57 suffered from malignant media infarction (MI) and 45 from traumatic brain injury (TBI).

Representative ICP values were measured by the hour, beginning at patient's admittance on ICU. Furthermore sex, side of DC, level of hemoglobin (HB) and platelets (PLT), INR, pTT, CRP, type of sedation, duration of sedation, GCS and NIHSS respectively were evaluated. Laboratory findings were collected on the first postsurgical day. Favorable outcome was defined as MRS≤4 after rehabilitation. Using parametric statistics, probability values of p<0.05 were considered significant.

Results: Favorable outcome occurred in 42 cases (54.8% males), unfavorable outcome in 60 cases (68.3%). Mean age in the former group was 52.2 yrs (range 23-72) versus 53.9 yrs (range 14-79) in the latter. Mean follow-up was 119 days. There were no statistically significant differences between the groups regarding age, sex, side of DC, INR, pTT CRP, GCS, NIHSS, type and duration of sedation. Patients in both outcome groups were continuously sedated during the observed period.

Unfavorable outcome was found to be associated with a significantly higher mean ICP during the first 96 hours (17.8 vs. 11.0mmHg; p<0.001). HB and PLT showed a significant lower level in patients with unfavorable outcome (mean 9.79 vs. 10.57g/dl and 176.2 vs. 204.9*109/L; both p<0.05) (Figure 1 [Fig. 1]).

Conclusions: Higher levels of HB and PLT seem to be of predictive value for better clinical outcome.

Early course of commonly tolerated ICP-values is associated with heterogeneous clinical outcome in patients undergoing DC. The significant difference of ICP values between favorable and unfavorable outcome already occurs in the very first hours after DC and remains constant. Surprisingly in both groups ICP values do barely exceed 20mmHg, indicating that only 5-15 mmHg is a safe ICP corridor, where good clinical outcome can be expected. Our data add an important aspect, that has to be further analyzed, concerning early ICP-levels predicting the clinical outcome.