Intracranial pressure monitoring in patients with spontaneous intracerebral hemorrhage

View More View Less
  • 1 Departments of Neurological Surgery,
  • 4 Neurology, and
  • 5 Public Health Sciences, University of Virginia, Charlottesville, Virginia;
  • 2 Department of Neurosurgery, University of Louisville, Louisville, Kentucky;
  • 3 Department of Neurosurgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York;
  • 6 Department of Neurology, University of Illinois, Chicago, Illinois; and
  • 7 Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The utility of ICP monitoring and its benefit with respect to outcomes after ICH is unknown. The aim of this study was to compare intracerebral hemorrhage (ICH) outcomes in patients who underwent intracranial pressure (ICP) monitoring to those who were managed by care-guided imaging and/or clinical examination alone.

METHODS

This was a retrospective analysis of data from the Ethnic/Racial variations of Intracerebral Hemorrhage (ERICH) study between 2010 and 2015. ICH patients who underwent ICP monitoring were propensity-score matched, in a 1:1 ratio, to those who did not undergo ICP monitoring. The primary outcome was 90-day mortality. Secondary outcomes were in-hospital mortality, hyperosmolar therapy use, ICH evacuation, length of hospital stay, and 90-day modified Rankin Scale (mRS) score, excellent outcome (mRS score 0–1), good outcome (mRS score 0–2), Barthel Index, and health-related quality of life (HRQoL; measured by EQ-5D and EQ-5D visual analog scale [VAS] scores). A secondary analysis for patients without intraventricular hemorrhage was performed.

RESULTS

The ICP and no ICP monitoring cohorts comprised 566 and 2434 patients, respectively. The matched cohorts comprised 420 patients each. The 90-day and in-hospital mortality rates were similar between the matched cohorts. Shift analysis of 90-day mRS favored no ICP monitoring (p < 0.001). The rates of excellent (p < 0.001) and good (p < 0.001) outcome, Barthel Index (p < 0.001), EQ-5D score (p = 0.026), and EQ-5D VAS score (p = 0.004) at 90 days were lower in the matched ICP monitoring cohort. Rates of mannitol use (p < 0.001), hypertonic saline use (p < 0.001), ICH evacuation (p < 0.001), and infection (p = 0.001) were higher, and length of hospital stay (p < 0.001) was longer in the matched ICP monitoring cohort. In the secondary analysis, the matched cohorts comprised 111 patients each. ICP monitoring had a lower rate of 90-day mortality (p = 0.041). Shift analysis of 90-day mRS, Barthel Index, and HRQoL metrics were comparable between the matched cohorts.

CONCLUSIONS

The findings of this study do not support the routine utilization of ICP monitoring in patients with ICH.

ABBREVIATIONS aβ = adjusted β; aOR = adjusted odds ratio; ERICH = Ethnic/Racial variations of Intracerebral Hemorrhage; GCS = Glasgow Coma Scale; HRQoL = health-related quality of life; ICH = intracerebral hemorrhage; ICP = intracranial pressure; IVH = intraventricular hemorrhage; mRS = modified Rankin Scale; OR = odds ratio; RR = rate ratio; TBI = traumatic brain injury; VAS = visual analog scale.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Ching-Jen Chen: University of Virginia Health System, Charlottesville, VA. chenjared@gmail.com.

INCLUDE WHEN CITING Published online May 31, 2019; DOI: 10.3171/2019.3.JNS19545.

Disclosures Dr. Southerland reports non–study-related personal fees from Neurology Podcast, personal fees from Expert Legal Review, grants from American Heart Association/American Stroke Association, grants from American Academy of Neurology, grants from American Board of Psychiatry and Neurology, and a pending patent on mobile telemedicine for rapid evaluation of acute stroke (serial number: 61/867,477).

  • 1

    Broderick JP, Brott T, Tomsick T, Huster G, Miller R: The risk of subarachnoid and intracerebral hemorrhages in blacks as compared with whites. N Engl J Med 326:733736, 1992

    • Search Google Scholar
    • Export Citation
  • 2

    Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, : Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery 80:615, 2017

    • Search Google Scholar
    • Export Citation
  • 3

    Chambers IR, Banister K, Mendelow AD: Intracranial pressure within a developing intracerebral haemorrhage. Br J Neurosurg 15:140141, 2001

    • Search Google Scholar
    • Export Citation
  • 4

    Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, : A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 367:24712481, 2012

    • Search Google Scholar
    • Export Citation
  • 5

    Dennis MS, Burn JP, Sandercock PA, Bamford JM, Wade DT, Warlow CP: Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project. Stroke 24:796800, 1993

    • Search Google Scholar
    • Export Citation
  • 6

    Farrell B, Godwin J, Richards S, Warlow C: The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry 54:10441054, 1991

    • Search Google Scholar
    • Export Citation
  • 7

    Hamani C, Zanetti MV, Pinto FC, Andrade AF, Ciquini O Jr, Marino R Jr: Intraventricular pressure monitoring in patients with thalamic and ganglionic hemorrhages. Arq Neuropsiquiatr 61 (2B):376380, 2003

    • Search Google Scholar
    • Export Citation
  • 8

    Hanley DF, Thompson RE, Muschelli J, Rosenblum M, McBee N, Lane K, : Safety and efficacy of minimally invasive surgery plus alteplase in intracerebral haemorrhage evacuation (MISTIE): a randomised, controlled, open-label, phase 2 trial. Lancet Neurol 15:12281237, 2016

    • Search Google Scholar
    • Export Citation
  • 9

    Hemphill JC III, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, : Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:20322060, 2015

    • Search Google Scholar
    • Export Citation
  • 10

    Kamel H, Hemphill JC III: Characteristics and sequelae of intracranial hypertension after intracerebral hemorrhage. Neurocrit Care 17:172176, 2012

    • Search Google Scholar
    • Export Citation
  • 11

    Keep RF, Hua Y, Xi G: Intracerebral haemorrhage: mechanisms of injury and therapeutic targets. Lancet Neurol 11:720731, 2012

  • 12

    Kleindorfer DO, Khoury J, Moomaw CJ, Alwell K, Woo D, Flaherty ML, : Stroke incidence is decreasing in whites but not in blacks: a population-based estimate of temporal trends in stroke incidence from the Greater Cincinnati/Northern Kentucky Stroke Study. Stroke 41:13261331, 2010

    • Search Google Scholar
    • Export Citation
  • 13

    Mahoney FI, Barthel DW: Functional evaluation: the Barthel Index. Md State Med J 14:6165, 1965

  • 14

    Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM: Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 382:397408, 2013

    • Search Google Scholar
    • Export Citation
  • 15

    Rankin J: Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 2:200215, 1957

  • 16

    Sacco S, Marini C, Toni D, Olivieri L, Carolei A: Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke 40:394399, 2009

    • Search Google Scholar
    • Export Citation
  • 17

    Shah M, Birnbaum L, Rasmussen J, Sekar P, Moomaw CJ, Osborne J, : Effect of hyperosmolar therapy on outcome following spontaneous intracerebral hemorrhage: Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study. J Stroke Cerebrovasc Dis 27:10611067, 2018

    • Search Google Scholar
    • Export Citation
  • 18

    Sykora M, Steinmacher S, Steiner T, Poli S, Diedler J: Association of intracranial pressure with outcome in comatose patients with intracerebral hemorrhage. J Neurol Sci 342:141145, 2014

    • Search Google Scholar
    • Export Citation
  • 19

    Tian Y, Wang Z, Jia Y, Li S, Wang B, Wang S, : Intracranial pressure variability predicts short-term outcome after intracerebral hemorrhage: a retrospective study. J Neurol Sci 330:3844, 2013

    • Search Google Scholar
    • Export Citation
  • 20

    van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ: Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 9:167176, 2010

    • Search Google Scholar
    • Export Citation
  • 21

    Vespa P, Hanley D, Betz J, Hoffer A, Engh J, Carter R, : ICES (Intraoperative Stereotactic Computed Tomography-Guided Endoscopic Surgery) for Brain Hemorrhage: a multicenter randomized controlled trial. Stroke 47:27492755, 2016

    • Search Google Scholar
    • Export Citation
  • 22

    Woo D, Rosand J, Kidwell C, McCauley JL, Osborne J, Brown MW, : The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study protocol. Stroke 44:e120e125, 2013

    • Search Google Scholar
    • Export Citation
  • 23

    Ziai WC, Melnychuk E, Thompson CB, Awad I, Lane K, Hanley DF: Occurrence and impact of intracranial pressure elevation during treatment of severe intraventricular hemorrhage. Crit Care Med 40:16011608, 2012

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 293 293 200
Full Text Views 93 93 74
PDF Downloads 87 87 58
EPUB Downloads 0 0 0