The effects of intracranial pressure monitoring in patients with traumatic brain injury

• Published in: PloS one Vol. 9; no. 2; p. e87432
• Main Authors: Su, Shao-Hua, Wang, Fei, Hai, Jian, Liu, Ning-Tao, Yu, Fei, Wu, Yi-Fang, Zhu, You-Hou
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21-02-2014; Public Library of Science (PLoS)
• Subjects: Brain; Brain injuries; Brain Injuries - pathology; Care and treatment; Clinical trials; Cohort analysis; Complications and side effects; Confidence intervals; Head injuries; Heterogeneity; Humans; Intracranial pressure; Intracranial Pressure - physiology; Length of Stay - statistics & numerical data; Mathematics; Medicine; Meta-analysis; Models, Statistical; Monitoring; Monitoring, Physiologic - adverse effects; Monitoring, Physiologic - methods; Monitoring, Physiologic - mortality; Mortality; Odds Ratio; Patient monitoring equipment; Patients; Pressure; Pressure effects; Sensitivity analysis; Studies; Systematic review; Traumatic brain injury; Vasoactive intestinal peptide; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0087432

Although international guideline recommended routine intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury(TBI), there were conflicting outcomes attributable to ICP monitoring according to the published studies. Hence, we conducted a meta-analysis to evaluate the efficacy and safety of ICP monitoring in patients with TBI.
Based on previous reviews, PubMed and two Chinese databases (Wangfang and VIP) were further searched to identify eligible studies. The primary outcome was mortality. Secondary outcomes included unfavourable outcome, adverse events, length of ICU stay and length of hospital stay. Weighted mean difference (WMD), odds ratio (OR) and 95% confidence intervals (CIs) were calculated and pooled using fixed-effects or random-effects model.
two randomized controlled trials (RCTs) and seven cohort studies involving 11,038 patients met the inclusion criteria. ICP monitoring was not associated with a significant reduction in mortality (OR, 1.16; 95% CI, 0.87-1.54), with substantial heterogeneity (I(2) = 80%, P<0.00001), which was verified by the sensitivity analyses. No significant difference was found in the occurrence of unfavourable outcome (OR, 1.40; 95% CI, 0.99-1.98; I(2) = 4%, P = 0.35) and adverse events (OR, 1.04; 95% CI, 0.64-1.70; I(2) = 78%, P = 0.03). However, we should be cautious to the result of adverse events because of the substantial heterogeneity in the comparison. Furthermore, longer ICU and hospital stay were the consistent tendency according to the pooled studies.
No benefit was found in patients with TBI who underwent ICP monitoring. Considering substantial clinical heterogeneity, further large sample size RCTs are needed to confirm the current findings.