{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:43:06Z","timestamp":1792201386928,"version":"4.4.0"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Community-acquired bacterial meningitis (CABM) is a severe condition associated with high mortality. In this study the first aim was to evaluate the incidence of intracranial pressure (ICP) insults and disturbances in cerebral vasomotor reactivity and the second aim was to evaluate the management and clinical outcome of CABM patients treated in the neurointensive care unit (NICU).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n CABM patients who were treated in the NICU of Uppsala University Hospital, Sweden, during 2008\u20132020 were included in the study. Data on demographics, admission variables, treatment, ICP dynamics, vasomotor reactivity, and short-term clinical outcome were evaluated in these patients.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Of 97 CABM patients, 81 (84%) received ICP monitoring, of whom 22% had ICP > 20 mm Hg during 5% or more of the monitoring time on day 1, which decreased to 9% on day 3. For those patients with ICP monitoring, 46% required CSF drainage, but last-tier ICP treatment, including thiopental (4%) and decompressive craniectomy (1%), was rare. Cerebral vasomotor reactivity was disturbed, with a mean pressure reactivity index (PRx) above 0.2 in 45% of the patients on day 1, and remained high for the first 3 days. In total, 81 (84%) patients had a favorable outcome (Glasgow Coma Scale motor score [GCS M] 6) at discharge, 9 (9%) patients had an unfavorable outcome (GCS M < 6) at discharge, and 7 (7%) patients died in the NICU. Those with favorable outcome had significantly better cerebral vasomotor reactivity (lower PRx) than the two other outcome groups (p < 0.01).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Intracranial hypertension was frequent following severe CABM and CSF drainage was often sufficient to control ICP. Cerebral vasomotor reactivity was commonly disturbed and associated with poor outcome. Clinical outcome was slightly better than in earlier studies.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2021.2.jns2148","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T13:53:03Z","timestamp":1629467583000},"page":"831-839","source":"Crossref","is-referenced-by-count":10,"title":["Intracranial pressure dynamics and cerebral vasomotor reactivity in community-acquired bacterial meningitis during neurointensive care"],"prefix":"10.3171","volume":"136","author":[{"given":"Teodor","family":"Svedung Wettervik","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Section of Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Howells","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Section of Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Ljunghill Hedberg","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Lew\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Section of Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Enblad","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Section of Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"r1","series-title":"Acta Anaesthesiol Scand","first-page":"732","article-title":"Neurointensive care of patients with severe community-acquired meningitis","volume":"55","author":"Edberg M","year":"2011","unstructured":"Edberg M, Furebring M, Sj\u00f6lin J, Enblad P. Neurointensive care of patients with severe community-acquired meningitis. Acta Anaesthesiol Scand. 2011;55(6):732\u2013739."},{"issue":"3","key":"r2","series-title":"PLoS One","first-page":"e91976","article-title":"Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study","volume":"9","author":"Glim\u00e5ker M","year":"2014","unstructured":"Glim\u00e5ker M, Johansson B, Halldorsdottir H, Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study. PLoS One. 2014;9(3):e91976."},{"issue":"3","key":"r3","series-title":"Clin Infect Dis","first-page":"384","article-title":"Reducing intracranial pressure may increase survival among patients with bacterial meningitis","volume":"38","author":"Lindvall P","year":"2004","unstructured":"Lindvall P, Ahlm C, Ericsson M, Reducing intracranial pressure may increase survival among patients with bacterial meningitis. Clin Infect Dis. 2004;38(3):384\u2013390."},{"issue":"3","key":"r4","series-title":"Acta Anaesthesiol Scand","first-page":"264","article-title":"Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis","volume":"46","author":"Gr\u00e4nde PO","year":"2002","unstructured":"Gr\u00e4nde PO, Myhre EB, Nordstr\u00f6m CH, Schliamser S. Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis. Acta Anaesthesiol Scand. 2002;46(3):264\u2013270."},{"issue":"1","key":"r5","series-title":"N Engl J Med","first-page":"44","article-title":"Community-acquired bacterial meningitis in adults","volume":"354","author":"van de Beek D","year":"2006","unstructured":"van de Beek D, de Gans J, Tunkel AR, Wijdicks EF. Community-acquired bacterial meningitis in adults. N Engl J Med. 2006;354(1):44\u201353."},{"issue":"20","key":"r6","series-title":"N Engl J Med","first-page":"1549","article-title":"Dexamethasone in adults with bacterial meningitis","volume":"347","author":"de Gans J","year":"2002","unstructured":"de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347(20):1549\u20131556."},{"issue":"5","key":"r7","series-title":"Neurosurg Focus","first-page":"E7","article-title":"The role of ICP monitoring in meningitis","volume":"43","author":"Tariq A","year":"2017","unstructured":"Tariq A, Aguilar-Salinas P, Hanel RA, The role of ICP monitoring in meningitis. Neurosurg Focus. 2017;43(5):E7."},{"issue":"1","key":"r8","series-title":"J Appl Physiol (1985)","first-page":"72","article-title":"Cerebral blood flow autoregulation in early experimental S. pneumoniae meningitis","volume":"102","author":"Pedersen M","year":"2007","unstructured":"Pedersen M, Brandt CT, Knudsen GM, Cerebral blood flow autoregulation in early experimental S. pneumoniae meningitis. J Appl Physiol (1985). 2007;102(1):72\u201378."},{"issue":"6","key":"r9","series-title":"J Cereb Blood Flow Metab","first-page":"914","article-title":"Microvascular changes during the early phase of experimental bacterial meningitis","volume":"10","author":"Pfister HW","year":"1990","unstructured":"Pfister HW, Koedel U, Haberl RL, Microvascular changes during the early phase of experimental bacterial meningitis. J Cereb Blood Flow Metab. 1990;10(6):914\u2013922."},{"issue":"4","key":"r10","series-title":"Crit Care Med","first-page":"1027","article-title":"Dependency of cerebral blood flow on mean arterial pressure in patients with acute bacterial meningitis","volume":"28","author":"M\u00f8ller K","year":"2000","unstructured":"M\u00f8ller K, Larsen FS, Qvist J, Dependency of cerebral blood flow on mean arterial pressure in patients with acute bacterial meningitis. Crit Care Med. 2000;28(4):1027\u20131032."},{"issue":"6","key":"r11","series-title":"Stroke","first-page":"1333","article-title":"Cerebral blood flow and metabolism during infusion of norepinephrine and propofol in patients with bacterial meningitis","volume":"35","author":"M\u00f8ller K","year":"2004","unstructured":"M\u00f8ller K, Qvist T, Tofteng F, Cerebral blood flow and metabolism during infusion of norepinephrine and propofol in patients with bacterial meningitis. Stroke. 2004;35(6):1333\u20131339."},{"issue":"5","key":"r12","series-title":"Stroke","first-page":"1116","article-title":"Effect of short-term hyperventilation on cerebral blood flow autoregulation in patients with acute bacterial meningitis","volume":"31","author":"M\u00f8ller K","year":"2000","unstructured":"M\u00f8ller K, Skinh\u00f8j P, Knudsen GM, Larsen FS. Effect of short-term hyperventilation on cerebral blood flow autoregulation in patients with acute bacterial meningitis. Stroke. 2000;31(5):1116\u20131122."},{"issue":"2","key":"r13","series-title":"Neurocrit Care","first-page":"221","article-title":"Bedside evaluation of cerebral energy metabolism in severe community-acquired bacterial meningitis","volume":"22","author":"Poulsen FR","year":"2015","unstructured":"Poulsen FR, Schulz M, Jacobsen A, Bedside evaluation of cerebral energy metabolism in severe community-acquired bacterial meningitis. Neurocrit Care. 2015;22(2):221\u2013228."},{"issue":"3","key":"r14","series-title":"Acta Anaesthesiol Scand","first-page":"329","article-title":"Patterns of cerebral tissue oxygen tension and cytoplasmic redox state in bacterial meningitis","volume":"63","author":"Larsen L","year":"2019","unstructured":"Larsen L, Nielsen TH, Nordstr\u00f6m CH, Patterns of cerebral tissue oxygen tension and cytoplasmic redox state in bacterial meningitis. 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BMJ. 1993;306(6883):953\u2013955."},{"key":"r17","article-title":"Bakteriella CNS-infektioner","author":"Svenska Infektionsl\u00e4karf\u00f6reningen","year":"2020","unstructured":"Svenska Infektionsl\u00e4karf\u00f6reningen; Brink M, Bruchfeld J, Fredlund O, Bakteriella CNS-infektioner. 2020. Accessed March 19, 2021. https:\/\/infektion.net\/wp-content\/uploads\/2020\/09\/vardprogram-bakt-cns-inf_200630_new.pdf"},{"issue":"2","key":"r18","series-title":"J Neurosurg","first-page":"311","article-title":"Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma","volume":"102","author":"Howells T","year":"2005","unstructured":"Howells T, Elf K, Jones PA, Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma. 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J Neurotrauma. 2019;36(11):1818\u20131827."},{"issue":"4","key":"r21","series-title":"J Neurosurg","first-page":"893","article-title":"Patient-specific thresholds of intracranial pressure in severe traumatic brain injury","volume":"120","author":"Lazaridis C","year":"2014","unstructured":"Lazaridis C, DeSantis SM, Smielewski P, Patient-specific thresholds of intracranial pressure in severe traumatic brain injury. J Neurosurg. 2014;120(4):893\u2013900."},{"issue":"4","key":"r22","series-title":"Crit Care Med","first-page":"733","article-title":"Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury","volume":"30","author":"Steiner LA","year":"2002","unstructured":"Steiner LA, Czosnyka M, Piechnik SK, Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. 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