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Brain Trauma Foundation (BTF) guidelines recommend intracranial pressure (ICP) monitoring in patients who sustained severe traumatic brain injury (TBI). Compliance to BTF guidelines is variable, and the effect of ICP monitoring on outcomes remains a controversial issue. The purpose of this study was to assess guidelines compliance in patients who sustain a severe TBI and to analyze the effect of ICP monitoring on outcomes.
Intracranial pressure (ICP) monitoring in severe TBI is recommended in the Brain Trauma Foundation (BTF) guidelines. The guidelines recommend ICP monitoring in patients with GCS 40 years, unilateral/bilateral motor posturing and systolic blood pressure
Variables extracted were demographics, comorbidities, mechanism of injury, injury specifics (epidural, subdural, subarachnoid, intracranial hemorrhage and diffuse axonal injury), AIS for each body area, Injury Severity Score (ISS), vital signs in the emergency department, ICP monitoring and type, compliance with BTF guidelines and craniectomy. Outcomes included in-hospital mortality, complications, ventilation days, intensive care unit (ICU) and hospital length of stay (HLOS), and functional independence at discharge.
The theoretical rationale for ICP monitoring is to maintain adequate cerebral blood flow and oxygenation by preventing or treating intracranial hypertension in a timely fashion. This, in turn, should decrease the risk of secondary brain injury and improve survival and neurologic functional outcomes. The extensively publicized relationship between intracranial hypertension and poor outcomes has led to the widespread use of ICP > 20 mmHg as the threshold for therapeutic interventions to lower the intracranial pressure. ICP monitoring can not only drive intervention, but also allow for evaluation of the response to various therapeutic pressure lowering interventions.
Intracranial hypertension (ICH) complicates roughly 25% of acute liver failure (ALF) patients with grade III/IV encephalopathy. Intracranial pressure (ICP) monitoring is controversial due to complications in 5 to 20% and absence of documented mortality benefit.
The most common etiology of ALF was acetaminophen (51%, P = 0.13 between groups). Of ICP monitored (ICPM) patients, 85% (n = 121) received devices within 24 hours of admission to study. ICPM patients were significantly younger (36 6 years vs. 43 15 years, P < 0.001) than controls, more likely to be on renal replacement therapy (48% vs. 31%, P < 0.001) but less likely to be on vasopressors (20% vs. 32%, P = 0.008). ICPM patients were given more ICH directed therapies (mannitol 43% vs. 13%, hypertonic saline 21% vs. 6%, hypothermia 29% vs. 11%, P < 0.001 for each comparison). For ICPM patients, the median INR on the day of monitor insertion was 2.2 (1.6 to 2.9) and platelet count 116 (84 to 171); 74% were given FFP (vs. 46% controls, P < 0.001) and 19% (vs. 14% controls, P = 0.14) received platelets. ICP monitoring was also strongly associated with listing (78% vs. 27%, P < 0.001) and receipt of liver transplant (42% vs. 18%, P < 0.001). Twenty-one-day mortality was similar between ICPM patients (33%) and controls (37%, P = 0.33) when all or only nontransplanted patients (46% vs. 45%, 0.8) were considered. Of 66 ICPM patients with detailed information, 18 (29%) had evidence of ICH (ICP >25 mmHg) at the time of ICPM insertion (maximum ICP on day 1 18 (12 to 26) mmHg). Of 49 patients with a known ICPM device, 14 patients received epidural catheters, six subdural, 11 intraparenchymal, seven intraventricular and 11 lumbar monitors. In only one of 49 ICPM patients was intracranial hemorrhage reported, and this patient survived.
In ALF patients, ICP monitor placement is strongly associated with liver transplantation but not with overall or transplant free mortality. In the absence of ICP monitoring, ALF patients may be less aggressively treated for intracranial hypertension. The value of ICP monitoring in ALF remains to be determined but ICPM placement clearly affects the frequency of interventions for elevated ICP.
Intracranial pressure (ICP) monitoring is recommended for severe traumatic brain injuries (TBI) but some data suggests it may not improve outcomes. The objective was to investigate the effect of ICP monitoring among TBI.
Severe traumatic brain injury (TBI) management focuses on preventing secondary insults [1]. The Brain Trauma Foundation severe TBI guideline recommends treatment guided by monitoring modalities including intracranial pressure (ICP) monitors [2]. They state that Level 2B evidence shows ICP monitoring may reduce mortality rates [2]. The Brian Injury Guideline, recommends that severe TBIs, categorized as Brain Injury Guideline 3, receive repeat imaging, a neurosurgeon consultation, and are admitted to the hospital, but have no ICP monitoring recommendations [3].
The COVID-19 pandemic had a significant impact on the intracranial pressure monitoring market owing to the factors such as the diversion of resources to COVID-19 patients, the decline in the footfall of patients other than COVID-19 at hospitals and clinics, and cancellation or rescheduling of procedures, among other factors. Several studies reported that COVID-19 had a severe impact on people with medical conditions like traumatic brain injury (TBI), which may have increased the demand for intracranial pressure monitoring. For instance, according to a research study published in September 2021, by the National Institute of Health, elderly patients with moderate to severe Traumatic Brain Injury (TBI) experienced a considerably higher risk of in-hospital mortality if they had a coronavirus infection and the patients with COVID-19 were 5.45 times more at risk to expire before discharge than the TBI patients who were not COVID-19 positive. Hence, COVID-19 had a significant impact on the intracranial pressure monitoring market. However, currently, the market has reached its pre-pandemic nature in terms of demand for the products and is expected to witness strong growth in the coming years.
Key factors propelling the market growth include the increasing prevalence of neurodegenerative disorders, the growing geriatric population, increasing cases of head and brain injury, and increasing awareness and technological advancements in intracranial pressure monitoring.
Similarly, according to another study by the National Institute of Health published in March 2022, the overall annual incidence of Intracerebral Hemorrhage (ICH) in the United States is 23.15 per 100,000 people, and it has been observed that ICH incidence increased with age and its increasing in young and middle-aged Americans. Hence, the high burden of diseases associated with the head and brain is expected to fuel growth in the intracranial pressure monitoring market over the forecast period.
Furthermore, technological advancements in the field of intracranial pressure monitoring are expected to propel market growth. For instance, in February 2021, in order to provide alarms to clinicians directly from its cerebral ultrasound gadget, Novasignal Corporation released a cloud-based app. The new app enables clinicians to receive immediate notifications from the Novaguide device, a transcranial Doppler ultrasound technology that combines robotics and artificial intelligence to provide real-time monitoring of blood flow in the brain (AI).
Hence, owing to the above-mentioned factors, the intracranial pressure monitoring market is expected to grow over the forecast period. However, the lack of skilled professionals and the high cost associated with intracranial pressure monitoring is expected to restrain the growth of the market over the forecast period.
According to a study from the National Institute of Health published in June 2022, intracranial pressure was most frequently brought on by traumatic brain injuries, which commonly result from car accidents, violent acts, sports injuries, explosions, and other types of combat traumas, and thus, the high burden of road accidents in developing and under-developing countries are further expected to have a significant impact on the growth of TBI segment. Therefore, due to the above-mentioned factors, the traumatic brain injury segment is expected to have a significant share of the studied market over the forecast period.
The North American region is expected to occupy a significant market share in the intracranial pressure monitoring market over the forecast period owing to the presence of a high burden of head and brain injury/diseases, robust healthcare infrastructure, and the presence of some of the key players of the market in the region.
In the North American region, the United States is expected to be a major market owing to a high prevalence of diseases demanding intracranial pressure monitoring, the launch of new products, and the presence of an esteemed healthcare system in the country. For instance, according to the research study from the American Heart Association published in March 2022, the overall annual incidence of Intracerebral Hemorrhage (ICH) in the United States is 23.15 per 100,000 people, and it has been observed that ICH incidence increased with age and its increasing in young and middle-aged Americans.
Additionally, the technological advancement in the devices used in monitoring intracranial pressure is further expected to boost market growth. For instance, in November 2021, FUJIFILM Healthcare Americas Corporation launched its advanced, high-field open MRI system called Velocity MRI System during the 2021 Radiological Society of North America (RSNA) event. Therefore, due to the above-mentioned factors, the North American region is expected to have a significant share in the intracranial pressure monitoring market during the forecast period. 153554b96e
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