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.
ObjectiveTo investigate the feasibility of electroencephalography (EEG) power spectrum analysis monitoring noninvasive intracranial pressure (ICP). MethodsBetween September 2008 and May 2009, the EEG signals were recorded in 62 patients (70 cases/times) with central nervous system (CNS). By using self-designed software, EEG power spectrum analysis was conducted and pressure index (PI) was calculated automatically. ICP was measured by lumbar puncture (LP). ResultsThe mean ICP was (239.74±116.25) mm H2O (70-500 mm H2O, 1 mm H2O=0.009 8 kPa), and 52.9% of patients had increased ICP. The mean PI was 0.29±0.20 (0.02-0.85). The Spearman rank test showed that there was a significant negative correlation between PI and ICP (rs=-0.849, P<0.01). The data from the patients with diffuse lesions of CNS and focal lesions were analyzed separately; the results showed there were significant negative correlations between PI and ICP in both groups (rs=-0.815, -0.912; P<0.01). ConclusionThe PI obtained from EEG analysis is correlated with ICP. Analysis of specific parameters from EEG power spectrum might reflect the ICP. Further research should be carried out.
At present, the monitoring methods fwor intracranial pressure adopted in clinical practice are almost all invasive. The invasive monitoring methods for intracranial pressure were accurate, but they were harmful to the patient's body. Therefore, non-invasive methods for intracranial pressure monitoring must be developed. Since 1980, many non-invasive methods have been sprung out in succession, but they can not be used clinically. In this paper, research contents and progress of present non-invasive intracranial pressure monitoring are summarized. Advantages and disadvantages of various ways are analyzed. And finally, perspectives of development for intracranial pressure monitoring are presented.
We used near-infrared spectroscopy technology to monitor and assess the treatment effect of dehydrating agent in injured rat brain in real time style. We employed the brain edema model in rats resulting from Feeney's freefall damage, then treated with different doses of mannitol, and collected reduced scattering coefficient (μ's) and intracranial pressure (ICP) values after the injury and during the treatment. The results showed that brain edema happened 1 h after the injury in rats' brain tissue, peaked around 72 h after injury, and then began to decrease gradually. The reduced scattering coefficient and ICP values of the treatment group injected with mannitol all decreased after administration. Compared with the effect of low-dose mannitol treatment, that of high-dose mannitol treatment was much better. The duration of the plateau was longer and most experiments results declined significantly. From this we conclude that the reduced scattering coefficient and ICP are consistent with the trend changes, and the reduced scattering coefficient could be used as an indicator for monitoring cerebral edema.