Zeng and colleagues examine the impact of treatment based on monitored intracranial pressure (ICP) versus that delivered without monitoring on both 6-month neurologic outcome (Glasgow Outcome Scale score) and renal function.5 They report significantly better recovery and less renal dysfunction in monitored patients managed in accordance with the Brain Trauma Foundation guidelines.
Unfortunately, these authors do not present data sufficient to support their claim of improved outcome. Neither do they securely establish that ICP monitoring would be associated with less renal failure if this study were repeated elsewhere.
Patients were parsed into monitored versus non-monitored groups according to
International Society of Nephrology: KDIGO Clinical Practice Guideline for Acute Kidney Injury. KI Supplements2:March2012. (http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO%20AKI%20Guideline.pdf) [Accessed July 3 2013]
ZengJTongWZhengP: Decreased risk of acute kidney injury with intracranial pressure monitoring in patients with moderate or severe brain injury. Clinical article. J Neurosurg[epub ahead of print August 2 2013. DOI: 10.3171/2013.7.JNS122131]
CremerOLvan DijkGWvan WensenEBrekelmansGJFMoonsKGMLeenenLPH: Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med33:2207–22132005
MauritzWSteltzerHBauerPDolanski-AghamanoukjanLMetnitzP: Monitoring of intracranial pressure in patients with severe traumatic brain injury: an Austrian prospective multicenter study. Intensive Care Med34:1208–12152008