Intracranial Pressure Monitoring Fails to Help Traumatic Brain Injury Patients: Study

Monitoring for intracranial pressure following a head trauma appears to provide little, if any, benefits to patients who have suffered a traumatic brain injury (TBI), and in some cases may have worsened their condition, according to the findings of a new study.

In findings published on September 27 in the medical journal JAMA Network Open, researchers indicate critically ill brain injury patients who received intracranial pressure (ICP) monitoring undergo more medical and surgical intervention than patients who were not monitored, and were actually more likely to suffer respiratory complications, infections, and other health problems.

Traumatic brain injuries can occur from a forceful blow to the head, or an object that pierces the skull. The injuries can disrupt normal brain function, cause permanent disability, and may result in death.

Patients who suffer severe TBI commonly experience elevated intracranial pressure, and the growing pressure inside of the skull can lead to uncontrolled intracranial hypertension. This can result in life-threatening consequences if the condition is not treated, can shift the brain’s structure, block blood supply to the brain or compress the brain stem, which can lead to hemorrhaging and a stroke.

Intracranial Pressure Monitoring for Traumatic Brain Injuries

Prior studies have suggested that critically ill TBI patients may benefit from ICP monitoring devices, which are placed inside of the head and monitor skull pressure to detect and treat intracranial hypertension.

In this latest study, Italian researchers analyzed data on 1,448 patients admitted to intensive care units with a TBI in Italy and Hungary, of which 503 patients received intracranial pressure monitoring, and 945 patients did not.

While mortality rates were similar in both monitored and unmonitored TBI patients, monitored patients were found to suffer higher rates of moderate and severe disability, respiratory and infectious complications, required more treatments and longer periods of mechanical ventilation or hospitalization, and had lower rates of good recovery outcomes than unmonitored patients did after a period of six months.

The researchers suggested that the poorer outcomes of monitored TBI patients could be the result of adverse side effects from the increased medical interventions. Those interventions may have been spurred by the increased monitoring. However, researchers indicate that intracranial pressure monitoring requires further investigation and observational studies to improve TBI patient recovery outcomes.

“This study found a significant association between ICP monitoring and worse patient outcomes, which could be explained by the increased use of medical therapies, with their significant adverse effects, among monitored patients,” the researchers concluded. “This result does not question the value of knowing the ICP values but how they should be used to improve patient outcome.”