Increased intracranial pressure in patients with traumatic brain injury in the intensive care unit

Abstract

Increased intracranial pressure (ICP) after traumatic brain injury (TBI) is an important factor of secondary brain injury. The measurement and management of ICP in TBI patients, therefore, remain the cornerstone of clinical management. The current thesis describes several studies on the measurement and management of ICP in this patient population with a focus on invasive ICP monitoring and analgo-sedation.

The first part of this thesis focuses on the measurement of ICP in TBI patients. An in-depth analysis (chapter 2) was done to compare external ventricular drains (EVD) versus intraparenchymal monitors (IPM). In the next chapter (chapter 3) the role of big data (BD) in the treatment and management of TBI patients is discussed. As an example of BD and machine learning (ML) in the management of TBI patients, a ML model was developed that can accurately and robustly classify ICP waveforms as originating from an EVD or IPM (chapter 4).

The second part of this thesis focuses on the analgo-sedative management of TBI patients in the ICU. An international survey was conducted to quantify practice-pattern variation in neurotrauma sedation management (chapter 5). In addition, a retrospective analysis was performed to quantify the different sedation intensities administered in TBI patients (chapter 6). Finally, the effect of midazolam-based sedation vs. non-midazolam-based sedation on the need for ICP rescue therapies and clinical outcome was investigated (chapter 7).

In the final part of this thesis (chapter 8) the importance of implementing a palliative care approach for TBI patients in the ICU is discussed.