Evidence-Based Treatment for Increased Intracranial Pressure after Acute Traumatic Brain Injury_Chinese Journal of Evidence-Based Medicine

Authors：

QIAN Zhicheng ,  KANG Yan

ICU, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

KANG Yan, Email: qianzc2008@163.com

Keywords：

Increased intracranial pressure; Pharmacotherapy; Non-pharmacotherapy; Evidence-based treatment

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Objective 　To identify evidence-based treatment choices for a patient with increased intracranial pressure after acute traumatic brain injury.
Methods 　We searched The Cochrane Library (Issue 2, 2006), MEDLNE (1981 to August 2006) and CBMdisc (1978 to August 2006) to identity systematic reviews (SRs), randomized controlled trials (RCTs), controlled clinical trials (CCTs) and prospective cohort studies involving the efficacy and safety of pharmacotherapy and non-pharmacotherapy for increased intracranial pressure after acute traumatic brain injury.
Results 　We found 2 SRs and 8 RCTs on pharmacotherapy, and 6 SRs and 2 RCTs on non-pharmacotherapy. Conventional-dose mannitol was no better than hypertonic saline, but was better than other intracranial pressure lowering agents. High-dose mannitol can reduce mortality and the incidence of severe disability compared with conventional-dose mannitol. There were no studies comparing high-dose mannitol and hypertonic saline. Non-pharmacotherapy was not recommended for routine use due to the lack of good quality evidence.
Conclusion 　For patients with increased intracranial pressure after acute traumatic brain injury, mannitol is effective in reducing the mortality and the incidence of severe disability. However, more large-scale RCTs are required to compare high-dose mannitol versus other drugs. Non-pharmacotherapy is not recommended as an adjunct therapy at present.

Citation： QIAN Zhicheng,KANG Yan. Evidence-Based Treatment for Increased Intracranial Pressure after Acute Traumatic Brain Injury. Chinese Journal of Evidence-Based Medicine, 2007, 07(2): 153-157. doi: Copy

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7.	Afifi W, Abdallah I, Yosry M, et al. The effect of a single dose of 3% hypertonic saline versus mannitol 20% for treatment of brain oedema and intracranial hypertension in postoperative patients with supratentorial gliomata. Egyptian Journal of Anaesthesia, 2003, 19(4): 371–379.
8.	Renaud V, Jacques A, Laurent T, et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med, 2003, 31: 1683–1687.
9.	Biestro A, Alberti R, Galli R, et al. Osmotherapy for increased intracranial pressure: comparison between mannitol and glycerol. Acta neurochirurgica, 1997; 39(8): 725–732, discussion 732–733.
10.	钱东翔, 黄东健, 郭宝平, 等. 甘油果糖对脑损伤后血液流变学的影响. 中国临床康复, 2004, 8(22): 4518–4520.
11.	Schwartz M, Tator C, Rowed D, et al. The University of Toronto head injury treatment study: A prospective, randomized comparison of Pentobarbital and Mannitol. CAN-J-NEUROL-SCI, 1984; 11(4): 434–440.
12.	Julio C, Giulio M, Kazuo O. Improving Clinical Outcomes from Acute Subdural Hematomas with the Emergency Preoperative Administration of High Doses of Mannitol: A Randomized Trial. Neurosurgery, 2001, 49: 864–871.
13.	Julio C, Giulio M, Kazuo O. Major Clinical and Physiological Benefits of Early High Doses of Mannitol for Intraparenchymal Temporal Lobe Hemorrhages With Abnormal Pupillary Widening: a Randomized Trial. Neurosurgery, 2002, 51: 628–638.
14.	Alderson P, Gadkary C, Signorini DF. Therapeutic hypothermia for head injury. The Cochrane Database of Systematic Reviews, 2006, Issue 2.
15.	McIntyre LA, Fergusson DA, Hébert PC, et al. Prolonged therapeutic hypothermia after traumatic brain injury in adults: a systematic review. Database of Abstracts of Reviews of Effects, 2006, Issue 2.
16.	Slade J, Kerr ME, Marion D. Effect of therapeutic hypothermia on the incidence and treatment of intracranial hypertension. The Journal of neuroscience nursing, 1999, 31(5): 264–269.
17.	Marion DW, Obrist WD, Carlier PM, et al. The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report. Journal of neurosurgery, 1993, 79(3): 354–362.
18.	Hayashi S, Inao S, Takayasu M, et al. Effect of early induction of hypothermia on severe head injury. Acta Neurochir, 2002, 81(Suppl): 83–84.
19.	Bennett MH, Trytko B, Jonker B. Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain injury. The Cochrane Database of Systematic Reviews,2006, Issue 2.
20.	Roberts I, Schierhout G. Hyperventilation therapy for acute traumatic brain injury. The Cochrane Database of Systematic Reviews,2006, Issue 2.
21.	Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. The Cochrane Database of Systematic Reviews, 2006, Issue 2.

1. Qian DX, Huang DJ, Guo BP, et al. Effect of glycerol fructose on hemorrheologic properties after brain injury. Chinese Journal Of Clinical Rehabilitation, 2004, 8(22): 4518–4520.
2. Guyatt GH, R ennie D, Editors. The Evidence-Based Mdicine Working Group. Users’ Guides to the Mdical Literature: A Mannual for Evidence-based Clinical Practice. Chicago: AMA Press. 2002.
3. Phillips B, Ball C, Sackett D, et al. Levels of evidence and grades of recommendation. Available from: URL: http://www.cebm.net.
4. Wakai A, Roberts I, Schierhout G. Mannitol for acute traumatic brain injury. The Cochrane Database of Systematic Reviews, 2006, Issue 2.
5. Roberts I. Barbiturates for acute traumatic brain injury. The Cochrane Database of Systematic Reviews, 1999, Issue 3.
6. Battison C, Andrews PJ, Graham C, et al. Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med, 2005, 33: 196–202.
7. Afifi W, Abdallah I, Yosry M, et al. The effect of a single dose of 3% hypertonic saline versus mannitol 20% for treatment of brain oedema and intracranial hypertension in postoperative patients with supratentorial gliomata. Egyptian Journal of Anaesthesia, 2003, 19(4): 371–379.
8. Renaud V, Jacques A, Laurent T, et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med, 2003, 31: 1683–1687.
9. Biestro A, Alberti R, Galli R, et al. Osmotherapy for increased intracranial pressure: comparison between mannitol and glycerol. Acta neurochirurgica, 1997; 39(8): 725–732, discussion 732–733.
10. 钱东翔, 黄东健, 郭宝平, 等. 甘油果糖对脑损伤后血液流变学的影响. 中国临床康复, 2004, 8(22): 4518–4520.
11. Schwartz M, Tator C, Rowed D, et al. The University of Toronto head injury treatment study: A prospective, randomized comparison of Pentobarbital and Mannitol. CAN-J-NEUROL-SCI, 1984; 11(4): 434–440.
12. Julio C, Giulio M, Kazuo O. Improving Clinical Outcomes from Acute Subdural Hematomas with the Emergency Preoperative Administration of High Doses of Mannitol: A Randomized Trial. Neurosurgery, 2001, 49: 864–871.
13. Julio C, Giulio M, Kazuo O. Major Clinical and Physiological Benefits of Early High Doses of Mannitol for Intraparenchymal Temporal Lobe Hemorrhages With Abnormal Pupillary Widening: a Randomized Trial. Neurosurgery, 2002, 51: 628–638.
14. Alderson P, Gadkary C, Signorini DF. Therapeutic hypothermia for head injury. The Cochrane Database of Systematic Reviews, 2006, Issue 2.
15. McIntyre LA, Fergusson DA, Hébert PC, et al. Prolonged therapeutic hypothermia after traumatic brain injury in adults: a systematic review. Database of Abstracts of Reviews of Effects, 2006, Issue 2.
16. Slade J, Kerr ME, Marion D. Effect of therapeutic hypothermia on the incidence and treatment of intracranial hypertension. The Journal of neuroscience nursing, 1999, 31(5): 264–269.
17. Marion DW, Obrist WD, Carlier PM, et al. The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report. Journal of neurosurgery, 1993, 79(3): 354–362.
18. Hayashi S, Inao S, Takayasu M, et al. Effect of early induction of hypothermia on severe head injury. Acta Neurochir, 2002, 81(Suppl): 83–84.
19. Bennett MH, Trytko B, Jonker B. Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain injury. The Cochrane Database of Systematic Reviews,2006, Issue 2.
20. Roberts I, Schierhout G. Hyperventilation therapy for acute traumatic brain injury. The Cochrane Database of Systematic Reviews,2006, Issue 2.
21. Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. The Cochrane Database of Systematic Reviews, 2006, Issue 2.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Treatment for Increased Intracranial Pressure after Acute Traumatic Brain Injury

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