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An overview of systematic reviews on the pharmacological randomized controlled trials for reducing intracranial pressure after traumatic brain injury
Department of Neurology and Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, United States.
NYU Steinhardt, Department of Occupational Therapy, New York University, New York, United States.
Marymount Center for Optimal Aging, School of Health Sciences, College of Health and Education, Marymount University, VA, Arlington, United States.
Marymount Center for Optimal Aging, School of Health Sciences, College of Health and Education, Marymount University, VA, Arlington, United States.
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2022 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 36, no 7, p. 829-840Article, review/survey (Refereed) Published
Abstract [en]

Background: There is a need for an overview of systematic reviews (SRs) examining randomized clinical trials (RCTs) of pharmacological interventions in the treatment of intracranial pressure (ICP) post-TBI.

Objectives: To summarize pharmacological effectiveness in decreasing ICP in SRs with RCTs and evaluate study quality.

Methods: Comprehensive literature searches were conducted in MEDLINE, PubMed, EMBASE, PsycINFO, and Cochrane Library databases for English SRs through October 2020. Inclusion criteria were SRs with RCTs that examined pharmacological interventions to treat ICP in patients post-TBI. Data extracted were participant characteristics, pharmacological interventions, and ICP outcomes. Study quality was assessed with AMSTAR-2.

Results: Eleven SRs between 2003 and 2020 were included. AMSTAR-2 ratings revealed 3/11 SRs of high quality. Pharmacological interventions included hyperosmolars, neuroprotectives, anesthetics, sedatives, and analgesics. Study samples ranged from 7 to 1282 patients. Hyperosmolar agents and sedatives were beneficial in lowering elevated ICP. High bolus dose opioids had a more deleterious effect on ICP. Neuroprotective agents did not show any effects in ICP management. RCT sample sizes and findings in the SRs varied. A lack of detailed data syntheses was noted. AMSTAR-2 analysis revealed moderate-to-high quality in most SRs. Future SRs may focus on streamlined reporting of dosing and clearer clinical recommendations.

Conclusions: PROSPERO-Registration: CRD42015017355.

Place, publisher, year, edition, pages
Taylor & Francis, 2022. Vol. 36, no 7, p. 829-840
Keywords [en]
intracranial pressure, pharmacological interventions, randomized control trials, Systematic review, traumatic brain injury
National Category
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-197731DOI: 10.1080/02699052.2022.2087102ISI: 000812091200001PubMedID: 35708261Scopus ID: 2-s2.0-85132383691OAI: oai:DiVA.org:umu-197731DiVA, id: diva2:1680259
Available from: 2022-07-04 Created: 2022-07-04 Last updated: 2023-03-24Bibliographically approved

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Hu, Xiaolei

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