Meningitis

Intracranial pressure monitoring in pediatric bacterial meningitis: a fancy or useful tool? A case report.

Authors: Sala F, Abbruzzese C, Galli D, Grimaldi M, Abate MG, Sganzerla EP, Citerio G.

This study indicates that ICP-targeted treatment in children improves the outcome of severe cases of bacterial meningitis. ICP monitoring could particularly be useful to optimize brain perfusion and provide relief from severe neurological impairment, which is associated with the clinical signs of meningitis and increased ICP levels. 

Reducing Intracranial Pressure May Increase Survival among Patients with Bacterial Meningitis

Authors: Peter Lindvall1, Clas Ahlm2, Mats Ericsson2, Leif Gothefors3, Silvana Naredi4, and Lars-Owe D. Koskinen1 

(1Department of Neurosurgery, Umeå University Hospital, Umeå, Sweden. 2Division of Infectious Diseases, Department of Clinical Microbiology, Umeå University Hospital, Umeå, Sweden. 3Department of Paediatrics, Umeå University Hospital, Umeå, Sweden. 4Department of Anaesthesia and Intensive Care, Umeå University Hospital, Umeå, Sweden)

Clin Infect Dis. (2004) 38 (3).

We reported findings concerning continuous intracranial pressure (ICP) and cerebral perfusion pressure (CPP) measurements and mortality in patients with severe bacterial meningitis treated on the basis of an ICP-targeted approach. Eighteen patients with severe bacterial meningitis were admitted for neurointensive care at Umeå University Hospital (Umeå, Sweden). In 15 patients, ICP was measured continuously through an ICP measuring device. During care, all patients but one developed intracranial hypertension with an ICP of ⩾15 mm Hg (14 of 15 patients). Ten (67%) of 15 patients survived and were discharged, and 5 patients (33%) died. Mean ICP was significantly higher and CPP was markedly decreased in nonsurvivors, compared with survivors. Among the survivors, ICP was gradually reduced. Treatment of patients with severe bacterial meningitis should include neurointensive care and continuous ICP measurement. Increased ICP may be reduced by using the ICP-targeted therapy that closely resembles the “Lund concept.”

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