Early prediction of neurological outcome after barbiturate coma therapy in patients undergoing brain tumor surgery
After a difficult brain tumor surgery, refractory intracranial hypertension (RICH) may occur due to residual tumor or post-operative complications such as hemorrhage, infarction, and aggravated brain edema. We investigated which predictors are associated with prognosis when using barbiturate coma th...
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| creator | Ryu, Jeong-Am Jung, Wonkyung Jung, Yoo Jin Kwon, Do Yeon Kang, Kina Choi, Hyeok Kong, Doo-Sik Seol, Ho Jun Lee, Jung-Il |
| description | After a difficult brain tumor surgery, refractory intracranial hypertension (RICH) may occur due to residual tumor or post-operative complications such as hemorrhage, infarction, and aggravated brain edema. We investigated which predictors are associated with prognosis when using barbiturate coma therapy (BCT) as a second-tier therapy to control RICH after brain tumor surgery. The study included adult patients who underwent BCT after brain tumor surgery between January 2010 and December 2016. The primary outcome was neurological status upon hospital discharge, which was assessed using the Glasgow Outcome Scale (GOS). In the study period, 4,296 patients underwent brain tumor surgery in total. Of these patients, BCT was performed in 73 patients (1.7%). Among these 73 patients, 56 (76.7%) survived to discharge and 25 (34.2%) showed favorable neurological outcomes (GOS scores of 4 and 5). Invasive monitoring of intracranial pressure (ICP) was performed in 60 (82.2%) patients, and revealed that the maximal ICP within 6 h after BCT was significantly lower in patients with favorable neurological outcome as well as in survivors (p = 0.008 and p = 0.028, respectively). Uncontrolled RICH (ICP ≥ 22 mm Hg within 6 h of BCT) was an important predictor of mortality after BCT (adjusted hazard ratio 12.91, 95% confidence interval [CI] 2.788-59.749), and in particular, ICP ≥ 15 mm Hg within 6 h of BCT was associated with poor neurological outcome (adjusted odds ratio 9.36, 95% CI 1.664-52.614). Therefore, early-controlled ICP after BCT was associated with clinical prognosis. There were no significant differences in the complications associated with BCT between the two neurological outcome groups. No BCT-induced death was observed. The active and timely control of RICH may be beneficial for clinical outcomes in patients with RICH after brain tumor surgery. |
| doi_str_mv | 10.1371/journal.pone.0215280 |
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We investigated which predictors are associated with prognosis when using barbiturate coma therapy (BCT) as a second-tier therapy to control RICH after brain tumor surgery. The study included adult patients who underwent BCT after brain tumor surgery between January 2010 and December 2016. The primary outcome was neurological status upon hospital discharge, which was assessed using the Glasgow Outcome Scale (GOS). In the study period, 4,296 patients underwent brain tumor surgery in total. Of these patients, BCT was performed in 73 patients (1.7%). Among these 73 patients, 56 (76.7%) survived to discharge and 25 (34.2%) showed favorable neurological outcomes (GOS scores of 4 and 5). Invasive monitoring of intracranial pressure (ICP) was performed in 60 (82.2%) patients, and revealed that the maximal ICP within 6 h after BCT was significantly lower in patients with favorable neurological outcome as well as in survivors (p = 0.008 and p = 0.028, respectively). Uncontrolled RICH (ICP ≥ 22 mm Hg within 6 h of BCT) was an important predictor of mortality after BCT (adjusted hazard ratio 12.91, 95% confidence interval [CI] 2.788-59.749), and in particular, ICP ≥ 15 mm Hg within 6 h of BCT was associated with poor neurological outcome (adjusted odds ratio 9.36, 95% CI 1.664-52.614). Therefore, early-controlled ICP after BCT was associated with clinical prognosis. There were no significant differences in the complications associated with BCT between the two neurological outcome groups. No BCT-induced death was observed. The active and timely control of RICH may be beneficial for clinical outcomes in patients with RICH after brain tumor surgery.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0215280</identifier><identifier>PMID: 30995269</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Active control ; Adult ; Barbiturates - administration & dosage ; Biology and Life Sciences ; Brain ; Brain cancer ; Brain damage ; Brain Edema - etiology ; Brain Edema - mortality ; Brain Edema - therapy ; Brain Neoplasms - mortality ; Brain Neoplasms - physiopathology ; Brain Neoplasms - surgery ; Brain surgery ; Brain tumors ; Care and treatment ; Cerebral edema ; Cerebral infarction ; Clinical outcomes ; Coma ; Coma - chemically induced ; Coma - mortality ; Coma - physiopathology ; Complications ; Confidence intervals ; Disease-Free Survival ; Drugs ; Edema ; Female ; Head injuries ; Hemorrhage ; Humans ; Hypertension ; Infarction ; Intensive care ; Intracranial hypertension ; Intracranial pressure ; Intracranial Pressure - drug effects ; Laboratories ; Male ; Medical prognosis ; Medical research ; Medicine ; Medicine and Health Sciences ; Mercury ; Middle Aged ; Mortality ; Nervous system ; Neurosurgery ; Nursing ; Patient outcomes ; Patients ; Physiology ; Postoperative Complications - mortality ; Postoperative Complications - physiopathology ; Postoperative Complications - therapy ; Prognosis ; Research and Analysis Methods ; Risk factors ; Surgery ; Survival Rate ; Therapy ; Traumatic brain injury ; Tumor removal ; Tumors</subject><ispartof>PloS one, 2019-04, Vol.14 (4), p.e0215280-e0215280</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Ryu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Ryu et al 2019 Ryu et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-17bb22e6032af54abb0ff8522fb8ac66ab8a4705fd7648c1dbd30b3f009d4d9d3</citedby><cites>FETCH-LOGICAL-c692t-17bb22e6032af54abb0ff8522fb8ac66ab8a4705fd7648c1dbd30b3f009d4d9d3</cites><orcidid>0000-0001-8143-5513</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469802/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469802/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30995269$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ryu, Jeong-Am</creatorcontrib><creatorcontrib>Jung, Wonkyung</creatorcontrib><creatorcontrib>Jung, Yoo Jin</creatorcontrib><creatorcontrib>Kwon, Do Yeon</creatorcontrib><creatorcontrib>Kang, Kina</creatorcontrib><creatorcontrib>Choi, Hyeok</creatorcontrib><creatorcontrib>Kong, Doo-Sik</creatorcontrib><creatorcontrib>Seol, Ho Jun</creatorcontrib><creatorcontrib>Lee, Jung-Il</creatorcontrib><title>Early prediction of neurological outcome after barbiturate coma therapy in patients undergoing brain tumor surgery</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>After a difficult brain tumor surgery, refractory intracranial hypertension (RICH) may occur due to residual tumor or post-operative complications such as hemorrhage, infarction, and aggravated brain edema. We investigated which predictors are associated with prognosis when using barbiturate coma therapy (BCT) as a second-tier therapy to control RICH after brain tumor surgery. The study included adult patients who underwent BCT after brain tumor surgery between January 2010 and December 2016. The primary outcome was neurological status upon hospital discharge, which was assessed using the Glasgow Outcome Scale (GOS). In the study period, 4,296 patients underwent brain tumor surgery in total. Of these patients, BCT was performed in 73 patients (1.7%). Among these 73 patients, 56 (76.7%) survived to discharge and 25 (34.2%) showed favorable neurological outcomes (GOS scores of 4 and 5). Invasive monitoring of intracranial pressure (ICP) was performed in 60 (82.2%) patients, and revealed that the maximal ICP within 6 h after BCT was significantly lower in patients with favorable neurological outcome as well as in survivors (p = 0.008 and p = 0.028, respectively). Uncontrolled RICH (ICP ≥ 22 mm Hg within 6 h of BCT) was an important predictor of mortality after BCT (adjusted hazard ratio 12.91, 95% confidence interval [CI] 2.788-59.749), and in particular, ICP ≥ 15 mm Hg within 6 h of BCT was associated with poor neurological outcome (adjusted odds ratio 9.36, 95% CI 1.664-52.614). Therefore, early-controlled ICP after BCT was associated with clinical prognosis. There were no significant differences in the complications associated with BCT between the two neurological outcome groups. No BCT-induced death was observed. The active and timely control of RICH may be beneficial for clinical outcomes in patients with RICH after brain tumor surgery.</description><subject>Active control</subject><subject>Adult</subject><subject>Barbiturates - administration & dosage</subject><subject>Biology and Life Sciences</subject><subject>Brain</subject><subject>Brain cancer</subject><subject>Brain damage</subject><subject>Brain Edema - etiology</subject><subject>Brain Edema - mortality</subject><subject>Brain Edema - therapy</subject><subject>Brain Neoplasms - mortality</subject><subject>Brain Neoplasms - physiopathology</subject><subject>Brain Neoplasms - surgery</subject><subject>Brain surgery</subject><subject>Brain tumors</subject><subject>Care and treatment</subject><subject>Cerebral edema</subject><subject>Cerebral infarction</subject><subject>Clinical outcomes</subject><subject>Coma</subject><subject>Coma - chemically induced</subject><subject>Coma - mortality</subject><subject>Coma - physiopathology</subject><subject>Complications</subject><subject>Confidence intervals</subject><subject>Disease-Free Survival</subject><subject>Drugs</subject><subject>Edema</subject><subject>Female</subject><subject>Head injuries</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Infarction</subject><subject>Intensive care</subject><subject>Intracranial hypertension</subject><subject>Intracranial pressure</subject><subject>Intracranial Pressure - drug effects</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Mercury</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nervous system</subject><subject>Neurosurgery</subject><subject>Nursing</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Physiology</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - physiopathology</subject><subject>Postoperative Complications - therapy</subject><subject>Prognosis</subject><subject>Research and Analysis Methods</subject><subject>Risk factors</subject><subject>Surgery</subject><subject>Survival Rate</subject><subject>Therapy</subject><subject>Traumatic brain injury</subject><subject>Tumor removal</subject><subject>Tumors</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9-L1DAQx4so3nn6H4gGBNGHXdOkTZsX4ThOXTg48NdrmKRpN0farEkq7n9vets7tnIPkocJM5_5JjPJZNnLHK9zWuUfbtzoB7DrnRv0GpO8JDV-lJ3mnJIVI5g-PtqfZM9CuMG4pDVjT7MTijkvCeOnmb8Eb_do53VjVDRuQK5Fgx69s64zCixyY1Su1wjaqD2S4KWJo4eoUXIDilvtYbdHZkA7iEYPMaBxaLTvnBk6JD2kSBx751EYfaf9_nn2pAUb9IvZnmU_Pl1-v_iyurr-vLk4v1opxklc5ZWUhGiGKYG2LEBK3LZ1SUgra1CMQTJFhcu2qVhRq7yRDcWSthjzpmh4Q8-y1wfdnXVBzO0KgpAc8woXjCRicyAaBzdi500Pfi8cGHHrcL4T4KNRVos64ZjXBSdlVVQc10xSyJnkktcKN0XS-jifNspeNyo1woNdiC4jg9mKzv0WrGC8xtNl3s0C3v0adYiiN0Fpa2HQbry9d04JZRQn9M0_6MPVzVQHqQAztC6dqyZRcV7WpEo1VBO1foBKq9G9UelvtSb5FwnvFwmJifpP7GAMQWy-ff1_9vrnkn17xG412LgNzo7TpwxLsDiAyrsQvG7vm5xjMY3GXTfENBpiHo2U9ur4ge6T7maB_gVcXQqO</recordid><startdate>20190417</startdate><enddate>20190417</enddate><creator>Ryu, Jeong-Am</creator><creator>Jung, Wonkyung</creator><creator>Jung, Yoo Jin</creator><creator>Kwon, Do Yeon</creator><creator>Kang, Kina</creator><creator>Choi, Hyeok</creator><creator>Kong, Doo-Sik</creator><creator>Seol, Ho Jun</creator><creator>Lee, Jung-Il</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-8143-5513</orcidid></search><sort><creationdate>20190417</creationdate><title>Early prediction of neurological outcome after barbiturate coma therapy in patients undergoing brain tumor surgery</title><author>Ryu, Jeong-Am ; Jung, Wonkyung ; Jung, Yoo Jin ; Kwon, Do Yeon ; Kang, Kina ; Choi, Hyeok ; Kong, Doo-Sik ; Seol, Ho Jun ; Lee, Jung-Il</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-17bb22e6032af54abb0ff8522fb8ac66ab8a4705fd7648c1dbd30b3f009d4d9d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Active control</topic><topic>Adult</topic><topic>Barbiturates - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ryu, Jeong-Am</au><au>Jung, Wonkyung</au><au>Jung, Yoo Jin</au><au>Kwon, Do Yeon</au><au>Kang, Kina</au><au>Choi, Hyeok</au><au>Kong, Doo-Sik</au><au>Seol, Ho Jun</au><au>Lee, Jung-Il</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early prediction of neurological outcome after barbiturate coma therapy in patients undergoing brain tumor surgery</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-04-17</date><risdate>2019</risdate><volume>14</volume><issue>4</issue><spage>e0215280</spage><epage>e0215280</epage><pages>e0215280-e0215280</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>After a difficult brain tumor surgery, refractory intracranial hypertension (RICH) may occur due to residual tumor or post-operative complications such as hemorrhage, infarction, and aggravated brain edema. We investigated which predictors are associated with prognosis when using barbiturate coma therapy (BCT) as a second-tier therapy to control RICH after brain tumor surgery. The study included adult patients who underwent BCT after brain tumor surgery between January 2010 and December 2016. The primary outcome was neurological status upon hospital discharge, which was assessed using the Glasgow Outcome Scale (GOS). In the study period, 4,296 patients underwent brain tumor surgery in total. Of these patients, BCT was performed in 73 patients (1.7%). Among these 73 patients, 56 (76.7%) survived to discharge and 25 (34.2%) showed favorable neurological outcomes (GOS scores of 4 and 5). Invasive monitoring of intracranial pressure (ICP) was performed in 60 (82.2%) patients, and revealed that the maximal ICP within 6 h after BCT was significantly lower in patients with favorable neurological outcome as well as in survivors (p = 0.008 and p = 0.028, respectively). Uncontrolled RICH (ICP ≥ 22 mm Hg within 6 h of BCT) was an important predictor of mortality after BCT (adjusted hazard ratio 12.91, 95% confidence interval [CI] 2.788-59.749), and in particular, ICP ≥ 15 mm Hg within 6 h of BCT was associated with poor neurological outcome (adjusted odds ratio 9.36, 95% CI 1.664-52.614). Therefore, early-controlled ICP after BCT was associated with clinical prognosis. There were no significant differences in the complications associated with BCT between the two neurological outcome groups. No BCT-induced death was observed. The active and timely control of RICH may be beneficial for clinical outcomes in patients with RICH after brain tumor surgery.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30995269</pmid><doi>10.1371/journal.pone.0215280</doi><tpages>e0215280</tpages><orcidid>https://orcid.org/0000-0001-8143-5513</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-04, Vol.14 (4), p.e0215280-e0215280 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2210970462 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Active control Adult Barbiturates - administration & dosage Biology and Life Sciences Brain Brain cancer Brain damage Brain Edema - etiology Brain Edema - mortality Brain Edema - therapy Brain Neoplasms - mortality Brain Neoplasms - physiopathology Brain Neoplasms - surgery Brain surgery Brain tumors Care and treatment Cerebral edema Cerebral infarction Clinical outcomes Coma Coma - chemically induced Coma - mortality Coma - physiopathology Complications Confidence intervals Disease-Free Survival Drugs Edema Female Head injuries Hemorrhage Humans Hypertension Infarction Intensive care Intracranial hypertension Intracranial pressure Intracranial Pressure - drug effects Laboratories Male Medical prognosis Medical research Medicine Medicine and Health Sciences Mercury Middle Aged Mortality Nervous system Neurosurgery Nursing Patient outcomes Patients Physiology Postoperative Complications - mortality Postoperative Complications - physiopathology Postoperative Complications - therapy Prognosis Research and Analysis Methods Risk factors Surgery Survival Rate Therapy Traumatic brain injury Tumor removal Tumors |
| title | Early prediction of neurological outcome after barbiturate coma therapy in patients undergoing brain tumor surgery |
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