naa a22 4500 510800211 CHVBK 20180411083352.0 cr unu---uuuuu 180411e20130601xx s 000 0 eng 10.1007/s12028-013-9832-3 doi (NATIONALLICENCE)springer-10.1007/s12028-013-9832-3 Timing of Intracranial Hypertension Following Severe Traumatic Brain Injury [Elektronische Daten] [Deborah Stein, Megan Brenner, Peter Hu, Shiming Yang, Erin Hall, Lynn Stansbury, Jay Menaker, Thomas Scalea] Background: We asked whether continuous intracranial pressure (ICP) monitoring data could provide objective measures of the degree and timing of intracranial hypertension (ICH) in the first week of neurotrauma critical care and whether such data could be linked to outcome. Methods: We enrolled adult (>17years old) patients admitted to our Level I trauma center within 6h of severe TBI. ICP data were automatically captured and ICP 5-minute means were grouped into 12-hour time periods from admission (hour 0) to >7days (hour 180). Means, maximum, percent time (% time), and pressure-times-time dose (PTD, mmHgh) of ICP >20mmHg and >30mmHg were calculated for each time period. Results: From 2008 to 2010, we enrolled 191 patients. Only 2.1% had no episodes of ICH. The timing of maximum PTD20 was relatively equally distributed across the 15 time periods. Median ICP, PTD20, %time20, and %time30 were all significantly higher in the 84-180h time period than the 0-84h time period. Stratified by functional outcome, those with poor functional outcome had significantly more ICH in hours 84-180. Multivariate analysis revealed that, after 84h of monitoring, every 5% increase in PTD20 was independently associated with 21% higher odds of having a poor functional outcome (adjusted odds ratio=1.21, 95% CI 1.02-1.42, p=0.03). Conclusions: Although early elevations in ICP occur, ICPs are the highest later in the hospital course than previously understood, and temporal patterns of ICP elevation are associated with functional outcome. Understanding this temporal nature of secondary insults has significant implications for management. Springer Science+Business Media New York, 2013 Traumatic brain injury nationallicence Intracranial pressure nationallicence Intracranial hypertension nationallicence Functional outcome nationallicence Stein Deborah Program in Trauma, Division of Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA aut Brenner Megan Program in Trauma, Division of Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA aut Hu Peter Shock Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA aut Yang Shiming Shock Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA aut Hall Erin Program in Trauma, Division of Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA aut Stansbury Lynn Shock Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA aut Menaker Jay Program in Trauma, Division of Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA aut Scalea Thomas Program in Trauma, Division of Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA aut Neurocritical Care Humana Press Inc 18/3(2013-06-01), 332-340 1541-6933 18:3<332 2013 18 12028 https://doi.org/10.1007/s12028-013-9832-3 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9832-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Stein Deborah Program in Trauma, Division of Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Brenner Megan Program in Trauma, Division of Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Hu Peter Shock Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Yang Shiming Shock Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Hall Erin Program in Trauma, Division of Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Stansbury Lynn Shock Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Menaker Jay Program in Trauma, Division of Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Scalea Thomas Program in Trauma, Division of Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 773 0- Neurocritical Care Humana Press Inc 18/3(2013-06-01), 332-340 1541-6933 18:3<332 2013 18 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer