Impact of Intracranial Pressure Monitoring on Prognosis of Patients With Severe Traumatic Brain Injury: A PRISMA Systematic Review and Meta-Analysis

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Abstract

To evaluate the influences of using intracranial pressure (ICP) monitoring on the prognosis of patients with severe traumatic brain injury.

Systematic search were conducted in PubMed, Embase, Cochrane Library, Wanfang, and CNKI. The eligible studies were identified for pooling analysis under fixed- or random effects model. Hospital mortality, functional outcomes, length of hospital stay, and the related complications in patients were extracted.

Six randomized controlled trials with 880 cases and 12 cohort studies with 12,606 cases were included. Combined analysis found that ICP monitoring was effective for reducing the risk rate of electrolyte disturbances (RR = 0.47, 95% confidence interval (CI): 0.63–0.90), rate of renal failure (RR = 0.50, 95% CI: 0.30–0.83), and for improving favorable prognosis (RR = 1.15, 95% CI: 1.00–1.35). However, ICP monitoring was not significant for hospital mortality (RR = 0.91, 95% CI: 0.77–0.1.06), decreasing rate of pulmonary infection (RR = 0.93, 95% CI: 0.76–1.14), rate of mechanical ventilation (RR = 1.02, 95% CI: 0.86–1.09), and duration of hospital stays (weighted mean difference (WMD) = 0.06, 95% CI: −0.03, 0.16).

ICP monitoring may not reduce the risk of hospital mortality, but plays a role in decreasing the rate of electrolyte disturbances, rate of renal failure, and increasing favorable functional outcome. However, effect of other outcomes need to be further confirmed in the future randomized controlled trials (RCTs) with larger sample size.

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