Neuroanesthesia & neurocritical care
Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study
Authors' conclusion
During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome.
Study context
- Population
- Acute brain-injured patients in intensive care unit (ICU), with/without intracranial pressure (ICP) monitoring, ICP treatment graded by Therapy Intensity Level (TIL) scale during first week of ICU admissionincluded in the analysis
- Participants
- 2,320 patients
- Comparison
- No-basic or mild-moderate TIL vs extreme TIL during first ICU week
- No-basic TILn = 382
- Mild-moderate TILn = 1,643
- eTILn = 295reference
- Primary endpoint
- Mortality
- Follow-up
- Six months
Methodological detailspreplanned subanalysis, multicentre, international
- Preplanned subanalysis
- Multicentre
- International
Primary result
As reported in the abstract
Each group vs eTILHazard ratio (95% CI)P value
No-basic TIL
1.612(1.243–2.091)
P < 0.001Mild-moderate TIL
1.017(0.823–1.257)
P = 0.873Further findings
Neurological outcome · six months
- No significant association between use of TIL and neurological outcome
Characteristics of eTIL vs other patients
- Median age, eTIL vs others (years)
- 49 (I-III quartiles = 35-62) vs 56 (40-69), p < 0.001
- Cardiovascular pre-injury comorbidities
- 859 (44%) vs 90 (31.4%), p < 0.001
- Neuroworsening episodes
- 160 (56.1%) vs 653 (33.3%), p < 0.001
- ICP device monitoring
- 221 (74.9%) vs 1037 (51.2%), p < 0.001
Variability of eTIL use
- Considerable variability in frequency and type of eTIL between centres and countries
Original publication
Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study. Intensive Care Med. Published 9 January 2023. doi:10.
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