An overview of systematic reviews on the pharmacological randomized controlled trials for reducing intracranial pressure after traumatic brain injury

ABSTRACT

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.

Conclusions

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. PROSPERO-Registration: CRD42015017355.

KEYWORDS:

• Systematic review
• traumatic brain injury
• pharmacological interventions
• intracranial pressure
• randomized control trials

Acknowledgments

The authors would like to thank the Applied Cognition TBI Task force from the American Congress of Rehabilitation Medicine for their contribution to this work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

This study was conducted through a collaborative effort from members of the Applied Cognition TBI Task force from the American Congress of Rehabilitation Medicine Measurement Networking Group. The taskforce members contributed equally to the intellectual content and a priori protocol design and implementation of this manuscript as well as the data abstraction. SK is the leading author of this manuscript, developed and organized the database, performing most of the statistical synthesis, interpretation of the data, and preparing the manuscript. MM, XH, PSW, DCW, and ST contributed to the introduction, results, and discussion sections of the manuscript. PS was responsible for the critical appraisal synthesis. PCH assisted with consultations and mentorship in all phases of the study. XH conceived of the study and contributed to preparing the manuscript, and critical revision. All authors approved the final version of the manuscript.

Protocol and Registration

PROSPERO International prospective register of systematic reviews (CRD4201501735). This protocol can be accessed at https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=1735

List of abbreviations

AMSTAR Assessment of Multiple Systematic Reviews

CPP Cerebral perfusion pressure

ICP Intracranial pressure

MA Meta-analysis

MAP Mean arterial pressure

PRISMA Preferred Reporting Items for Systematic Reviews and

Meta-Analyses

PROSPERO International Prospective Register of Systematic Review

RCTs Randomized controlled trials

SR Systematic Review

TBI Traumatic brain injury

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02699052.2022.2087102

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.