Devemos monitorar a pressão intracraniana de pacientes com TCE grave marshall II?

Abstract

Introduction: Intracranial pressure (ICP) monitoring is considered the standard of care for severe traumatic brain injury (TBI). A recent clinical trial concluded that care focused on maintaining monitored intracranial pressure at 20 mm Hg or less was not shown to be superior to care based on imaging and clinical examination. Purpose: Evaluate the relationship of intracranial hypertension with an increase of brain lesions, mortality and morbidity in patients with severe TBI Marshall II. Determine whether these patients need to have ICP monitored. Methods: Prospective observational cohort study on severe TBI patients (GCS8), Marshall CT classification II. Results: Seventy patients were divided into 2 groups based on ICP in the first 48h; G1: ICP 20mmHg (49 patients) and G2 ICP > 20mmHg (21 patients), 90% male, mean age 30.8 years, 78,5% sustained motor vehicle crash or pedestrian injuries, mean GCS 6. The most common CT findings were: subarachnoid hemorrhages and contusions (22 and 18 respectively). Seven patients died in G2 (33%) compared to 2 deaths in G1 (4%) (p<0.05). The OR of death was 11,7 times greater in G2 (95%CI: 2.2- 63,1). The median Glasgow outcome scale (GOS) score at 90 days was 2 in G2 and 5 in G1. New CT findings or progression were detected in 15 (71%) of G2 patients and in 5 (10%) G1 patients (p<0.05). The OR of new CT finding or progression was 22 times greater in G2 than G1 (95%CI: 5,02- 106,9). Two patients in G2 required surgery, none in G1. Conclusions: Severe TBI patients with Marshall score II and intracranial hypertension, are at greater risk for new CT abnormalities, worse prognosis, and higher mortality than those with no hypertension. ICP monitoring was crucial to define prognosis. Severe TBI Marshall II patients should be monitored.