Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study.

<h4>Objective</h4>To evaluate the efficacy of early intracranial pressure (ICP)-targeted treatment, compared to standard intensive care, in adults with community acquired acute bacterial meningitis (ABM) and severely impaired consciousness.<h4>Design</h4>A prospectively desig...

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Autores principales:	Martin Glimåker, Bibi Johansson, Halla Halldorsdottir, Michael Wanecek, Adrian Elmi-Terander, Per Hamid Ghatan, Lars Lindquist, Bo Michael Bellander
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8683a4de86f24eada9cd3b57d4254261
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spelling	oai:doaj.org-article:8683a4de86f24eada9cd3b57d42542612021-11-18T08:26:14ZNeuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study.1932-620310.1371/journal.pone.0091976https://doaj.org/article/8683a4de86f24eada9cd3b57d42542612014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24667767/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objective</h4>To evaluate the efficacy of early intracranial pressure (ICP)-targeted treatment, compared to standard intensive care, in adults with community acquired acute bacterial meningitis (ABM) and severely impaired consciousness.<h4>Design</h4>A prospectively designed intervention-control comparison study of adult cases from September 2004 to January 2012.<h4>Patients</h4>Included patients were confirmed ABM-cases, aged 16-75 years, with severely impaired mental status on admission. Fifty-two patients, given ICP-targeted treatment at the neuro-intensive care unit, and 53 control cases, treated with conventional intensive care, were included. All the patients received intensive care with mechanical ventilation, sedation, antibiotics and corticosteroids according to current guidelines. Additional ICP-treatment in the intervention group included cerebrospinal fluid drainage using external ventricular catheters (n = 48), osmotherapy (n = 21), hyperventilation (n = 13), external cooling (n = 9), gram-doses of methylprednisolone (n = 3) and deep barbiturate sedation (n = 2) aiming at ICP <20 mmHg and a cerebral perfusion pressure of >50 mmHg.<h4>Measurements</h4>The primary endpoint was mortality at two months and secondary endpoint was Glasgow outcome score and hearing ability at follow-up at 2-6 months.<h4>Outcomes</h4>The mortality was significantly lower in the intervention group compared to controls, 5/52 (10%) versus 16/53 (30%; relative risk reduction 68%; p<0.05). Furthermore, only 17 patients (32%) in the control group fully recovered compared to 28 (54%) in the intervention group (relative risk reduction 40%; p<0.05).<h4>Conclusions</h4>Early neuro-intensive care using ICP-targeted therapy, mainly cerebrospinal fluid drainage, reduces mortality and improves the overall outcome in adult patients with ABM and severely impaired mental status on admission.Martin GlimåkerBibi JohanssonHalla HalldorsdottirMichael WanecekAdrian Elmi-TeranderPer Hamid GhatanLars LindquistBo Michael BellanderPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 3, p e91976 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Martin Glimåker Bibi Johansson Halla Halldorsdottir Michael Wanecek Adrian Elmi-Terander Per Hamid Ghatan Lars Lindquist Bo Michael Bellander Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study.
description	<h4>Objective</h4>To evaluate the efficacy of early intracranial pressure (ICP)-targeted treatment, compared to standard intensive care, in adults with community acquired acute bacterial meningitis (ABM) and severely impaired consciousness.<h4>Design</h4>A prospectively designed intervention-control comparison study of adult cases from September 2004 to January 2012.<h4>Patients</h4>Included patients were confirmed ABM-cases, aged 16-75 years, with severely impaired mental status on admission. Fifty-two patients, given ICP-targeted treatment at the neuro-intensive care unit, and 53 control cases, treated with conventional intensive care, were included. All the patients received intensive care with mechanical ventilation, sedation, antibiotics and corticosteroids according to current guidelines. Additional ICP-treatment in the intervention group included cerebrospinal fluid drainage using external ventricular catheters (n = 48), osmotherapy (n = 21), hyperventilation (n = 13), external cooling (n = 9), gram-doses of methylprednisolone (n = 3) and deep barbiturate sedation (n = 2) aiming at ICP <20 mmHg and a cerebral perfusion pressure of >50 mmHg.<h4>Measurements</h4>The primary endpoint was mortality at two months and secondary endpoint was Glasgow outcome score and hearing ability at follow-up at 2-6 months.<h4>Outcomes</h4>The mortality was significantly lower in the intervention group compared to controls, 5/52 (10%) versus 16/53 (30%; relative risk reduction 68%; p<0.05). Furthermore, only 17 patients (32%) in the control group fully recovered compared to 28 (54%) in the intervention group (relative risk reduction 40%; p<0.05).<h4>Conclusions</h4>Early neuro-intensive care using ICP-targeted therapy, mainly cerebrospinal fluid drainage, reduces mortality and improves the overall outcome in adult patients with ABM and severely impaired mental status on admission.
format	article
author	Martin Glimåker Bibi Johansson Halla Halldorsdottir Michael Wanecek Adrian Elmi-Terander Per Hamid Ghatan Lars Lindquist Bo Michael Bellander
author_facet	Martin Glimåker Bibi Johansson Halla Halldorsdottir Michael Wanecek Adrian Elmi-Terander Per Hamid Ghatan Lars Lindquist Bo Michael Bellander
author_sort	Martin Glimåker
title	Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study.
title_short	Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study.
title_full	Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study.
title_fullStr	Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study.
title_full_unstemmed	Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study.
title_sort	neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/8683a4de86f24eada9cd3b57d4254261
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Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study.

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