The effects of intracranial pressure monitoring in patients with traumatic brain injury
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 eff...
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| Published in: | PloS one Vol. 9; no. 2; p. e87432 |
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| Abstract | 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. |
|---|---|
| AbstractList | Background
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.
Methods
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.
Results
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 (I2 = 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; I2 = 4%, P = 0.35) and advese events (OR, 1.04; 95% CI, 0.64–1.70; I2 = 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.
Conclusions
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. BACKGROUNDAlthough 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. METHODSBased 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. RESULTStwo 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. CONCLUSIONSNo 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. Background 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. Methods 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. Results 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.sup.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.sup.2 = 4%, P = 0.35) and advese events (OR, 1.04; 95% CI, 0.64-1.70; I.sup.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. Conclusions 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. BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. Background 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. Methods 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. Results 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 (I2 = 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; I2 = 4%, P = 0.35) and advese events (OR, 1.04; 95% CI, 0.64–1.70; I2 = 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. Conclusions 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. 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.sup.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.sup.2 = 4%, P = 0.35) and advese events (OR, 1.04; 95% CI, 0.64-1.70; I.sup.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. 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. |
| Audience | Academic |
| Author | Wang, Fei Liu, Ning-Tao Zhu, You-Hou Yu, Fei Hai, Jian Wu, Yi-Fang Su, Shao-Hua |
| AuthorAffiliation | The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China D'or Institute of Research and Education, Brazil |
| AuthorAffiliation_xml | – name: D'or Institute of Research and Education, Brazil – name: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China |
| Author_xml | – sequence: 1 givenname: Shao-Hua surname: Su fullname: Su, Shao-Hua organization: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China – sequence: 2 givenname: Fei surname: Wang fullname: Wang, Fei organization: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China – sequence: 3 givenname: Jian surname: Hai fullname: Hai, Jian organization: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China – sequence: 4 givenname: Ning-Tao surname: Liu fullname: Liu, Ning-Tao organization: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China – sequence: 5 givenname: Fei surname: Yu fullname: Yu, Fei organization: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China – sequence: 6 givenname: Yi-Fang surname: Wu fullname: Wu, Yi-Fang organization: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China – sequence: 7 givenname: You-Hou surname: Zhu fullname: Zhu, You-Hou organization: The Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24586276$$D View this record in MEDLINE/PubMed |
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| Copyright | COPYRIGHT 2014 Public Library of Science 2014 Su et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2014 Su et al 2014 Su et al |
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| DOI | 10.1371/journal.pone.0087432 |
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| Notes | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 Competing Interests: The authors have declared that no competing interests exist. Conceived and designed the experiments: SHS FW JH. Performed the experiments: SHS FW YFW FY YHZ JH. Analyzed the data: SHS FW YFW FY YHZ. Contributed reagents/materials/analysis tools: NTL. Wrote the paper: SHS FW JH. |
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| References_xml | – volume: 30 start-page: 1058 year: 2004 ident: ref4 article-title: R3-survey of traumatic brain injury management in European Brain IT centres year 2001 publication-title: Intensive Care Med doi: 10.1007/s00134-004-2206-8 contributor: fullname: P Enblad – volume: 5 start-page: 13 year: 2005 ident: ref21 article-title: Estimating the mean and variance from the median, range, and the size of a sample publication-title: BMC Med Res Methodo doi: 10.1186/1471-2288-5-13 contributor: fullname: SP Hozo – volume: 27 start-page: 400 year: 2001 ident: ref7 article-title: Intensive care management of head-injured patients in Europe: a survey from the European brain injury consortium publication-title: Intensive Care Med doi: 10.1007/s001340000825 contributor: fullname: N Stocchetti – ident: ref20 – volume: 43 start-page: 442 year: 2000 ident: ref6 article-title: Intracranial pressure monitoring and outcomes after traumatic brain injury publication-title: Can J Surg contributor: fullname: PL Lane – volume: 34 start-page: 1362 year: 2008 ident: ref25 article-title: Neuro-Intensive Care and Emergency Medicine (NICEM) Section of the European Society of Intensive Care Medicine: NICEM consensus on neurological monitoring in acute neurological disease publication-title: Intensive Care Med doi: 10.1007/s00134-008-1103-y contributor: fullname: PJ Andrews – volume: 34 start-page: 1208 year: 2008 ident: ref8 article-title: Monitoring of intracranial pressure in patients with severe traumatic brain injury: an Austrian prospective multicenter study publication-title: Intensive Care Med doi: 10.1007/s00134-008-1079-7 contributor: fullname: W Mauritz – volume: 47 start-page: 503 year: 1977 ident: ref3 article-title: Significance of intracranial hypertension in severe head injury publication-title: J Neurosurg doi: 10.3171/jns.1977.47.4.0503 contributor: fullname: JD Miller – volume: 139 start-page: 286 year: 1997 ident: ref24 article-title: EBIC-guidelines for management of severe head injury in adults. 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| Snippet | Although international guideline recommended routine intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury(TBI), there were... Background Although international guideline recommended routine intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury(TBI),... BACKGROUNDAlthough international guideline recommended routine intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury(TBI),... BACKGROUND: Although international guideline recommended routine intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury(TBI),... Background Although international guideline recommended routine intracranial pressure (ICP) monitoring for patients with severe traumatic brain injury(TBI),... |
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| SubjectTerms | 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 |
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| Title | The effects of intracranial pressure monitoring in patients with traumatic brain injury |
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