Research Reports - Decreased risk of acute kidney injury with intracranial pressure monitoring in patients with moderate or severe brain injury

J Neurosurg. 2013 Aug 2

Zeng J, Tong W, Zheng P

Object The authors undertook this study to evaluate the effects of continuous
intracranial pressure (ICP) monitoring-directed mannitol treatment on kidney
function in patients with moderate or severe traumatic brain injury (TBI).
Methods One hundred sixty-eight patients with TBI were prospectively assigned to
an ICP monitoring group or a conventional treatment control group based on the
Brain Trauma Foundation guidelines. Clinical data included the dynamic changes of
patients' blood concentrations of cystatin C, creatinine (Cr), and blood urea
nitrogen (BUN); mannitol use; and 6-month Glasgow Outcome Scale (GOS) scores.
Results There were no statistically significant differences with respect to
hospitalized injury, age, or sex distribution between the 2 groups. The incidence
of acute kidney injury (AKI) was higher in the control group than in the ICP
monitoring group (p < 0.05). The mean mannitol dosage in the ICP monitoring group
(443 ± 133 g) was significantly lower than in the control group (820 ± 412 g) (p
< 0.01), and the period of mannitol use in the ICP monitoring group (3 ± 3.8
days) was significantly shorter than in the control group (7 ± 2.3 days) (p <
0.01). The 6-month GOS scores in the ICP monitoring group were significantly
better than in the control group (p < 0.05). On the 7th, 14th, and 21st days
after injury, the plasma cystatin C and Cr concentrations in the ICP-monitoring
group were significantly higher than the control group (p < 0.05). Conclusions In
patients with moderate and severe TBI, ICP-directed mannitol treatment
demonstrated a beneficial effect on reducing the incidence of AKI compared with
treatment directed by neurological signs and physiological indicators.

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