A meta-analysis and systematic review of intracranial pressure monitoring on severe craniocerebral injury.

Abstract

A meta-analysis was carried out to study the effect of intracranial pressure monitoring on the prognosis of severe craniocerebral injury and to provide reference for treating craniocerebral diseases. A Boolean logic search method was adopted, and "intracranial pressure monitoring", "craniocerebral injury", "prognosis", and "brain injury" were set as search terms. The literature searched included PubMed, Medline, and the China National Knowledge Internet (CNKI), and literature that set non-intracranial pressure monitoring as a control for comparative research was screened. RevMan was then employed to perform the meta-analysis. 13 studies were included, most of which were of medium and high quality (low-risk bias). The results showed that no heterogeneous in-hospital mortality was found between groups (χ2=0.76, I2=0%, P=0.98) and the hospital mortality of experimental group was dramatically inferior to control (ctrl) group (Z=3.69, P=0.0002). Heterogeneity was found in the probability of favorable functional prognosis between groups (χ2=8.01, I2=50%, P=0.09) and the probability of favorable functional prognosis in experimental group was remarkably superior to that in ctrl group (Z=2.48, P=0.01). Incidence of renal failure was not heterogeneous between groups (χ2=3.17, I2=0%, P=0.53) and the incidence of renal failure in experimental group was notably inferior to ctrl group (Z=2.71, P=0.007). Finally, the incidence of lung infection in the two groups was heterogeneous (χ2=6.35, I2=37%, P=0.17) and incidence of lung infection in experimental group was dramatically lower versus ctrl group (Z=2.13, P=0.03). Our results showed Intracranial pressure monitoring can effectively reduce in-hospital mortality and the incidence of infection in patients with severe craniocerebral damage and enhance the functional prognosis of patients. Due to the inclusion criteria imposed in this study, the number of included articles was limited, and in future analyses the sample size should be increased to prevent bias.