Improvised intracranial pressure monitoring devices for traumatic brain injury management in a low-income environment: A single-centre randomised study demonstrating feasibility.
14-day mortality
Improvised intracranial pressure monitoring device
Intracranial pressure
Traumatic brain injury
Journal
Brain & spine
ISSN: 2772-5294
Titre abrégé: Brain Spine
Pays: Netherlands
ID NLM: 9918470888906676
Informations de publication
Date de publication:
2023
2023
Historique:
received:
28
11
2022
revised:
17
03
2023
accepted:
03
04
2023
medline:
29
6
2023
pubmed:
29
6
2023
entrez:
29
6
2023
Statut:
epublish
Résumé
The high cost and non-availability of standard ICP monitoring devices limit their use in low- and middle-income countries like Nigeria. This study aims to demonstrate the use of an improvised intraventricular ICP monitoring device as a feasible alternative. Are improvised ICP Monitoring devices feasible and effective in resource-constrained settings? The study was a prospective single-institution investigation involving 54 adult patients that presented with severe TBI (GCS of 3-8) within 72 h of injury and required operative intervention. All patients underwent craniotomy or primary decompressive craniectomy (DC) to evacuate traumatic mass lesions. 14-day in-hospital mortality was used as a primary endpoint of the study. 25 patients had ICP monitoring postoperatively using the improvised device. The modified ICP device was replicated using a feeding tube and a manometer with 0.9% saline as a coupling agent. Based on hourly ICP recording (up to 72 h), patients were observed as having high ICP (>27 cm H There was a 3-time higher mortality rate among the non-ICP monitored participants (31%) compared to the ICP-monitored participants (12%), although this did not reach statistical significance due to the small sample size. This preliminary study has shown that this modified ICP monitoring system is a relatively feasible alternative for diagnosing and treating elevated ICP in severe TBI in resource-constrained environments.
Sections du résumé
Background
UNASSIGNED
The high cost and non-availability of standard ICP monitoring devices limit their use in low- and middle-income countries like Nigeria. This study aims to demonstrate the use of an improvised intraventricular ICP monitoring device as a feasible alternative.
Research question
UNASSIGNED
Are improvised ICP Monitoring devices feasible and effective in resource-constrained settings?
Materials and methods
UNASSIGNED
The study was a prospective single-institution investigation involving 54 adult patients that presented with severe TBI (GCS of 3-8) within 72 h of injury and required operative intervention. All patients underwent craniotomy or primary decompressive craniectomy (DC) to evacuate traumatic mass lesions. 14-day in-hospital mortality was used as a primary endpoint of the study. 25 patients had ICP monitoring postoperatively using the improvised device.
Results
UNASSIGNED
The modified ICP device was replicated using a feeding tube and a manometer with 0.9% saline as a coupling agent. Based on hourly ICP recording (up to 72 h), patients were observed as having high ICP (>27 cm H
Discussion and conclusion
UNASSIGNED
There was a 3-time higher mortality rate among the non-ICP monitored participants (31%) compared to the ICP-monitored participants (12%), although this did not reach statistical significance due to the small sample size. This preliminary study has shown that this modified ICP monitoring system is a relatively feasible alternative for diagnosing and treating elevated ICP in severe TBI in resource-constrained environments.
Identifiants
pubmed: 37383472
doi: 10.1016/j.bas.2023.101737
pii: S2772-5294(23)00025-5
pmc: PMC10293291
doi:
Types de publication
Journal Article
Langues
eng
Pagination
101737Informations de copyright
© 2023 The Author(s).
Déclaration de conflit d'intérêts
The authors declare that they have no competing interests. All authors have approved the final manuscript for submission.
Références
Lancet. 2004 Oct 9-15;364(9442):1321-8
pubmed: 15474134
Crit Care Res Pract. 2012;2012:950393
pubmed: 22720148
Sensors (Basel). 2018 Feb 05;18(2):
pubmed: 29401746
Intensive Care Med. 2002 May;28(5):547-53
pubmed: 12029400
J Trauma. 1990 Aug;30(8):933-40; discussion 940-1
pubmed: 2117669
Neurology. 2001 Jun 26;56(12):1746-8
pubmed: 11425944
J Neurosurg. 1982 Apr;56(4):498-503
pubmed: 6801218
N Engl J Med. 2011 Apr 21;364(16):1493-502
pubmed: 21434843
Br J Anaesth. 2007 Jul;99(1):61-7
pubmed: 17548431
J Neurosurg. 1977 Oct;47(4):503-16
pubmed: 903804