Clinical values of ICP monitoring for patients with traumatic acute bilateral hemisphere diffuse brain swelling

Abstract

Objective To explore the guiding role of invasive intracranial pressure (ICP) monitoring in the treatment of posttraumatic acute bilateral hemispheric diffuse brain swelling,and to analyze the relationship between ICP and the prognosis.Methods A total of 59 patients with acute posttranmatic bilateral hemisphere diffuse brain swelling,treated under the monitoring of invasive intracranial pressure between Feb.2010 and Oct.2011,in our department were chosen for the study.ICP values at admission,before,and after decompressive craniectomy of all 59 patients were collected.The 59 patients were divided into a group of good recovery (GOS 4 ～ 5) and a group of bad recovery (GOS 1 ～ 3) based on the Glasgow outcome scale (COS) 6 months after craniocerebral trauma.The relationship between prognosis and ICP at admission,ICP before and after decompressive craniectomy was analyzed.Results The good recovery rate was 69％ (41/59) and the bad recovery rate was 31％ (18/59),while the death rate was 15％ (9/59).No mortality or plant survival occurred in patients whose GCS ≥ 9 at admission,and all patients,whose GCS were between 13 ～ 14,came back to work or study (GOS =5).Twenty-nine patients accepted decompressive cranieetomy under continuous invasive ICP monitoring; for those with good recoveries,ICP at admission,ICP before and after decompressive craniectomy were respectively (22.2 ± 7.9)mmHg,(31.9±9.5) mm Hg,and (123 ±2.9) mm Hg; for those with bad recoveries,these indexes were respectively (33.4 ±18.9) mm Hg,(43.7 ± 14.6) mm Hg,and (13.0 ±5.6)mm Hg.There were significant statistic differences between the two groups for the indexes of patients' ICP at admission and ICP before decompressive craniectomy (P＜ 0.05).However,there were no significant statistical differences of ICP after decompressive craniectomy (P＞ 0.05).Conclusion Continuous invasive ICP monitoring has an important role in guiding the treatments for patients of posttraumatic bilateral hemispheric acute diffuse brain swelling,whose prognosis were related to ICP at admission and ICP before decompressive craniectomy. Key words: Craniocerebral trauma; Diffuse brain swelling; ICP monitoring; Prognosis