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

Abstract

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.

Figure 1. Selection process for studies included in the meta-analysis.

Figure 2. Efficacy of ICP monitoring in the prevention of mortality.

According to Chesnut 2012, the clinical outcomes were evaluated by GOSE at 6 months. Although 157 patients and 167 patients in the ICP(+) group and ICP(−) group respectively, actually only 144 patients in ICP(+) group and 153 patients in ICP(−) group had been assessed at 6 months. ICP: intracranial pressure; GOSE: the extended glasgow outcome scale.

Figure 3. Efficacy of ICP monitoring in the prevention of unfavourable outcome, adverse events and hospital stay.

ICP: intracranial pressure.

Figure 4. Publication bias was assessed by inspection of funnel plots for mortality.

Dots was basically symmetrical distribution on both sides of dashed line, indicating that there was no obvious evidence of significant publication bias.