Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

• DOI: 10.1007/s00134-022-06937-1
• Publication Date: 2023-01-09T13:11:05Z
• Authors: Chiara Robba; Francesca Graziano; Angelo Guglielmi; Paola Rebora; Stefania Galimberti; Fabio S. Taccone; Giuseppe Citerio; ; Walter Videtta; Gustavo Domeniconi; María Estrella Gi...; Mariela Fumale; Edgar Daniel Amun...; Matias Casanova; Michael Reade; Elizabeth Hallt; David Pearson; Ian Seppelt; Raimund Helbok; Valery Davidovich; Geert Meyfroidt; Ilaria Alice Crippa; Liese Mebis; Patrick Biston; Stijn Van De Velde; Glorieux Denis; Pedro Kurtz; Samia Yasin Wayhs; Mypinder Sekhon; Donald Griesdale; Andrea Rigamonti; José Miguel Montes; Rodrigo Pérez-Araos; Jorge H. Mejia-Ma...; Andrés Gempeler; Ray Mendoza; Natasa Kovac; Hedgar Berty Guti...; Vera Spatenkova; Marek Fencl; Roman Gal; Ondrej Hrdy; Kamil Vrbica; Josef Skola; Eva Provaznikova; Jakub Kletecka; Pavel Lavicka; Vera Spatenkova; Piergiorgio Bresil; Marianne Levin; Piergiorgio Bresil; Josefine Thomsen; Thomas Egmose Larsen; Henrik Westy Hoff...; Morten Olskjaer Holm; Jesper Borg Andersen; Birgitte Majholm; Margit Smitt; Heidi Shil Eddelien; Manuel Jibaja; Freddy Maldonado; María Fernanda Ga...; Karim Asehnoune; Bertrand Pons; Gérard Audibert; Manon Lucca; Guillaume Besch; Pierluigi Banco; Karim Asehnoune; Raphael Cinotti; Hervé Q uintard; Benjamin Soyer; Anais Caillard; Clement Gakuba; Romain Sonneville; Stefan Wolf; Kristina Fuest; Lea Albrecht; Sarah Grotheer; Sandro M. Krieg; Stefan J. Schaller; Charikleia Vrettou; Eftychia Kontoudaki; Anna Efthymiou; Elena Palli; Demosthenes Makris; Chrysi Diakaki; Christina Iasonidou; Aikaterini Dimoula; Georgios Koukouli...; George Kyriazopoulos; Nikolas Pantelas; Syragoula Tsikriki; Electra Eleni Stamou; Charikleia Vrettou; Achileas Giannopo...; Eleni Mouloudi; Ping Shum Hoi; Yan Chan Cheuk; Hewa Kandamby Dar...; Krisztián Tánczos; Gabor Nardai; Zoltan Szentkereszty; Harsh Sapra; Deepak Gupta; Kaveri Sharma; Saurabh Anand; Ankur Luthra; Summit Bloria; Rajeev Chauhan; Nidhi Panda; Ahmad Ozair; Bram Kilapong; Anass Alsudani; Giuseppe Citerio; Alessandra Soragni; Alessandro Motta; Andrea Marudi; Elisabetta Bertel...; Anselmo Caricato; Camilla Gelormini; Eleonora Ioannoni; Eleonora Stival; Serena Silva; Federico Pozzi; Iole Brunetti; Andrea Cortegiani; Edoardo Picetti; Federico Villa; Italo Calamai; Maria Chiara Casadio; Maria Concetta Qu...; Marzia Grandis; Federico Magni; Silvia Del Bianco; Claudia Bonetti; Virginia Buldini; Aimone Giugni; Simone Maria Zerbi; Marco Carbonara; Antonella Cotoia; Antonio Izzi; Olegs Sabelnikovs; Muhammed Elhadi; Hazem Ahmed; Silvio A. Ñamendy...; Gilberto Adrian G...; Gentle S. Shrestha; Shirish Maskey; Tamanna Bajracharya; Khadka Nilam; Prakash Kafle; Laleet Rajbanshi; Yam Bahadur Roka; Olufemi Idowu; Khan Muhammad Muk...; Juan Luis Pinedo ...; Klaudyna Kojder; Irene Aragao; Ricardo Freitas; Marco Simoes; Dario Batista; Cecília Pacheco; Fátima Assunção; Luís Lencastre; Pedro Cavaleiro; Mohamed Abdelaty; Alex Gritsan; Sergey Khomiakov ...; Dovbysh Nikolay; Yaseen Arabi; Primoz Gradisek; Petra Forjan; Mara Škoti; Suada Filekovic R...; Primoz Gradisek; Nataša Milivojevic; Sergeja Kozar; Rafael Badenes; Aaron Blandino Ortiz; Mikel Celaya Lopez; Laura Galarza; Luisa Corral; Africa Lores; Ricard Soley; Laura Pariente; Pablo López Ojeda; Maria Dolores Ari...; Luis Javier Yuste...; Maria Isabel Gonz...; Mireia Anglada; Patricia Duque; Ainhoa Serrano; Berta Monleon; Vanessa Blazquez; Mauro Oddo; Samia Abed Maillard; Paola Morelli; John-Paul Miroz; Eva Favre; Walid Sellami; Massimo Lamperti; Jamil Dibu; Richard Sivities; Angelos Kolias; Chris Thompson; Christopher Hawth...; Justin Roberts; Lara Prisco; Roger Lightfoot; Josè I. Suarez; Luci Rivera-Lara; Susanne Muehlschl...; Juan Padilla; Sanjeev Sivakumar; Daiwai Olson
• Keywords: Quartile; Glasgow Outcome Scale; Grading scale

Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe therapeutical approaches used ABI, with/without pressure (ICP) monitoring, among different pathologies across countries, their association with six months mortality neurological outcome.A preplanned subanalysis SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort describing ICP treatment, graded according Therapy Intensity Level (TIL) scale, patients ABI during first week intensive care unit (ICU) admission.2320 were included analysis. The median age was 55 (I-III quartiles = 39-69) years, 800 (34.5%) female. During from ICU admission, no-basic TIL 382 (16.5%) patients, mild-moderate 1643 (70.8%), extreme 295 cases (eTIL, 12.7%). Patients who received eTIL younger (median 49 35-62) vs 56 (40-69) p < 0.001), less cardiovascular pre-injury comorbidities (859 (44%) 90 (31.4%), more episodes neuroworsening (160 (56.1%) 653 (33.3%), frequently monitored an device (221 (74.9%) 1037 (51.2%), 0.001). Considerable variability frequency use type adopted observed between centres countries. At months, had increased risk (Hazard ratio, HR 1.612, 95% Confidence Interval, CI 1.243-2.091, 0.001) compared eTIL. No difference when comparing (HR 1.017, 0.823-1.257, 0.873). significant outcome observed.During control high are used, especially TIL. In selected aggressive strategies can have beneficial effect on but not outcome.