This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Background Uncertainties exist regarding the indications, management, and effect of intracranial pressure (ICP) monitoring and treatment on outcome in patients with spontaneous intracranial hemorrhage (ICH).
Methods We performed an analysis of patients with spontaneous ICH enrolled in the SYNAPSE-ICU study, an international prospective observational study on the use of ICP monitoring. This study aimed to describe, in a large cohort of patients with spontaneous ICH admitted to the intensive care unit (ICU), the clinical practice of ICP monitoring, the occurrence of intracranial hypertension, and its therapeutic management. We assessed in-hospital mortality and the association between ICP monitoring and 6-month mortality and outcome by a propensity score approach with inverse probability weighting.
Results A total of 587 patients with ICH were included in this study; 281 (47.9%) received ICP monitoring. ICP-monitored patients, compared with nonmonitored patients, were younger (61 vs 67 years; p < 0.001), presented more frequently with both reactive pupils (67.2% vs 55.2%; p = 0.008), with better neurologic status at admission (Glasgow Coma Scale ≤8, 82.3% vs 88.8%; p = 0.038), and received higher therapy intensity level during the ICU stay. In 70.5% (170 out of 241) of ICP-monitored patients, the ICH score was equal to 3 or 4. Nearly half of monitored patients (46.6%) had at least one episode of ICP ≥20 mm Hg during the first week. An intraventricular catheter (53.6%) was the most frequently used device and was associated with fewer episodes of intracranial hypertension compared with the other monitoring devices (43.7% vs 64.9%, respectively). At weighted Cox regression model, ICP monitoring was associated with a significant reduction of 6-month mortality (hazard ratio 0.49 [95% CI 0.35–0.71; p = 0.001), but not with neurologic outcome (odds ratio 0.83 [95% CI 0.41–1.68]; p = 0.6077).
Conclusions ICP monitoring in ICH was utilized mainly in moderately severe cases. ICP monitoring was associated with a reduction of in-hospital and 6-month mortality but did not improve 6-month functional outcomes. Further research and randomized controlled trials to generate higher-level medical evidence to support guidelines regarding ICP use and treatment in patients with ICH are needed.
Trial Registration Information SYNAPSE-ICU: ClinicalTrials.gov NCT03257904.
Glossary
- AHA/ASA=
- American Heart Association/American Stroke Association;
- CPP=
- cerebral perfusion pressure;
- ESICM=
- European Society of Intensive Care Medicine;
- GCS=
- Glasgow Coma Scale;
- GOSE=
- Glasgow Outcome Scale Extended;
- HICP=
- intracranial hypertension;
- HICs=
- high-income countries;
- HR=
- hazard ratio;
- ICH=
- intracranial hemorrhage;
- ICP=
- intracranial pressure;
- ICU=
- intensive care unit;
- IVH=
- intraventricular hemorrhage;
- LMICs=
- low- and middle-income countries;
- MOR=
- median odds ratio;
- OR=
- odds ratio;
- TIL=
- therapy intensity level
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Coinvestigator appendix is available at links.lww.com/WNL/C11
Submitted and externally peer reviewed. The handling editor was José Merino, MD, MPhil.
Editorial, page 45
- Received November 11, 2021.
- Accepted in final form March 4, 2022.
- © 2022 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Efficacy of Ubrogepant in the Acute Treatment of Migraine With Mild Pain vs Moderate or Severe Pain
Dr. Kathleen Digre and Dr. Kendra Pham