Chapter title |
Patient-Specific Thresholds and Doses of Intracranial Hypertension in Severe Traumatic Brain Injury.
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Chapter number | 23 |
Book title |
Intracranial Pressure and Brain Monitoring XV
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Published in |
Acta neurochirurgica Supplement, January 2016
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DOI | 10.1007/978-3-319-22533-3_23 |
Pubmed ID | |
Book ISBNs |
978-3-31-922532-6, 978-3-31-922533-3
|
Authors |
Lazaridis, Christos, Smielewski, Peter, Menon, David K, Hutchinson, Peter, Pickard, John D, Czosnyka, Marek, Christos Lazaridis MD, Peter Smielewski PhD, David K. Menon MD, PhD, FMedSci, Peter Hutchinson FRCS (SN), PhD, John D. Pickard FRCS, MChir, FMedSci, Marek Czosnyka PhD, Menon, David K., Pickard, John D., Christos Lazaridis, Peter Smielewski, David K. Menon, Peter Hutchinson, John D. Pickard, Marek Czosnyka |
Editors |
Beng-Ti Ang |
Abstract |
Based on continuous monitoring of the pressure reactivity index (PRx), we defined individualized intracranial pressure (ICP) thresholds by graphing the relationship between ICP and PRx. We hypothesized that an "ICP dose" based on individually assessed ICP thresholds might correlate more closely with 6-month outcome compared with ICP doses derived from the recommended universal thresholds of 20 and 25 mmHg. Data from 327 patients with severe traumatic brain injury (TBI) were analyzed. ICP doses were computed as the cumulative area under the curve above the defined thresholds in graphing ICP versus time. The term Dose 20 (D20) was used to refer to an ICP threshold of 20 mm Hg. The markers D25 and DPRx were calculated similarly. The discriminative ability of each dose with regard to mortality was assessed by receiver operating characteristics analysis using fivefold cross-validation (CV). DPRx was found to be the best discriminator of mortality, despite the fact that D20 was twice as large as DPRx. Individualized doses of intracranial hypertension were stronger predictors of mortality than doses derived from the universal thresholds of 20 and 25 mm Hg. The PRx could offer a method of individualizing the ICP threshold. |
X Demographics
Geographical breakdown
Country | Count | As % |
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United Kingdom | 3 | 100% |
Demographic breakdown
Type | Count | As % |
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Practitioners (doctors, other healthcare professionals) | 2 | 67% |
Members of the public | 1 | 33% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 37 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Bachelor | 6 | 16% |
Other | 5 | 14% |
Student > Postgraduate | 5 | 14% |
Researcher | 3 | 8% |
Professor > Associate Professor | 2 | 5% |
Other | 3 | 8% |
Unknown | 13 | 35% |
Readers by discipline | Count | As % |
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Medicine and Dentistry | 15 | 41% |
Neuroscience | 4 | 11% |
Pharmacology, Toxicology and Pharmaceutical Science | 2 | 5% |
Engineering | 2 | 5% |
Social Sciences | 1 | 3% |
Other | 2 | 5% |
Unknown | 11 | 30% |