Association between invasive intracranial pressure monitoring and 1-year functional outcome in ICU patients with severe stroke: a pre-planned ancillary study of the SPICE prospective cohort (SPICE-ICP).
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Rolland David, Sonneville Romain, Mazighi Mikael, Pari Marie Hélène, Meyer Léa, Brahimi Younès, Doirado Mélanie, Collet Magalie, Gayat Etienne, Duranteau Jacques, Grégoire Charles, Sharshar Tarek, Naim Giulia, Cortier David, Jost Paul-Henri, Foucrier Arnaud, Bagate François, De Montmollin Etienne, Papin Grégory, Guidet Bertrand, Benghanem Sarah, Le Guennec Loïc, Megarbane Bruno, Toumert Karim, Demoule Alexandre, Diehl Jean-Luc, Tanaka Sébastien, Osman David, Pasquier Pierre, Lamara Fariza, Cariou Alain, Legriel Stephane, Crassard Isabelle, Boursin Perrine, Timsit Jean-François, Woimant France, Degos Vincent, Jacquens Alice
Аннотация
MATERIALS AND METHODS: We conducted a predefined ancillary study of the SPICE cohort (NCT03335995), comparing patients in ICU with ICP monitoring to those receiving standard monitoring following a stroke requiring mechanical ventilation. The primary outcome was an unfavourable one-year functional outcome, defined by a modified Rankin Scale (mRS) score between 4 and 6. The association between ICP monitoring and functional outcome was evaluated using a multivariate logistic regression and propensity score weighting analyses.
RESULTS: Among the 356 patients in the SPICE cohort, 129 (36%) underwent ICP monitoring (27 ischemic strokes, 50 intracerebral haemorrhages, and 52 subarachnoid haemorrhages). In the ICP group, 71 patients (55%) had an unfavourable functional outcome compared to 168 patients (74%) in the standard monitoring group (Odds Ratio (OR) 0.43 [95%CI, 0.27-0.68]). Patients in the ICP group were younger, had fewer comorbidities, and a less severe clinical presentation. After adjustment for age, Glasgow Coma Scale score, Charlson comorbidity index at admission, septic shock, cerebral oedema, and anisocoria, ICP monitoring was independently associated with lower odds of unfavourable functional outcome (OR 0.38, [95%CI 0.22-0.67]). In the propensity score-weighted analysis, the difference between groups was not statistically significant (OR 0.90 [95%CI, 0.80-1.01]).
CONCLUSION: ICP monitoring in severe stroke is more commonly employed in younger patients with fewer comorbidities. This monitoring does not appear to be an independent protective factor for a favourable one-year functional outcome when adjusted for confounders.