Association between invasive intracranial pressure monitoring and 1-year functional outcome in ICU patients with severe stroke: a pre-planned ancillary study of the SPICE prospective cohort (SPICE-ICP) - 04/10/26

Doi : 10.1016/j.accpm.2026.101838

David Rolland ^a, Romain Sonneville ^b,^c, Mikael Mazighi ^d,^e,^f,^g, Marie Hélène Pari ^a, Léa Meyer ^a, Younès Brahimi ^a, Mélanie Doirado ^a, Magalie Collet ^f, Etienne Gayat ^e,^h,ⁱ, Jacques Duranteau ^j, Charles Grégoire ^k, Tarek Sharshar ^l, Giulia Naim ^l, David Cortier ^m, Paul-Henri Jost ⁿ, Arnaud Foucrier ^o, François Bagate ⁿ, Etienne De Montmollin ^b, Grégory Papin ^b, Bertrand Guidet ^p, Sarah Benghanem ^q, Loïc Le Guennec ^r, Bruno Megarbane ^s, Karim Toumert ^t, Alexandre Demoule ^u, Jean-Luc Diehl ^v, Sébastien Tanaka ^w, David Osman ^x, Pierre Pasquier ^x, Fariza Lamara ^b, Alain Cariou ^q, Stephane Legriel ^y, Isabelle Crassard ^z, Perrine Boursin ^k, Jean-François Timsit ^b, France Woimant ^b,^f, Vincent Degos ^a,^aa,^ab, Alice Jacquens ^a,^aa,^ab,⁎

^a APHP, Department of Anesthesiology and Neurointensive Care, Pitié Salpétrière Hospital, Paris, France

^b APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75018, Paris, France

^c Université Paris Cité, INSERM UMR 1137, IAME, Paris, France

^d APHP Nord, Department of Neurology, Lariboisière University Hospital, Department of Interventional Neuroradiology, Fondation Rothschild Hospital, FHU Neurovasc, Paris, France

^e Université Paris Cité, INSERM UMR 1144, Paris, France

^f FHU NeuroVasc, France

^g Institut Universitaire de France, France

^h APHP.Nord, Department of Anesthesiology and Critical Care, DMU Parabol, Université Paris Cite, Paris, France

ⁱ University Paris Cité, Medical School, Paris, France

^j APHP, Department of Anesthesiology and Critical Care, Bicêtre University Hospitals, Le Kremlin Bicêtre, France

^k Department of Intensive Care, Rothschild Hospital Foundation, Paris, France

^l Department of Neuroanesthesiology and Intensive Care, Sainte Anne Hospital, Paris, France

^m Department of Intensive Care, Foch Hospital, Paris, France

ⁿ APHP, Department of Anesthesiology and Intensive Care, Henri Mondor Hospital, Creteil, France

^o APHP, Department of Anesthesiology and Critical Care, Beaujon University Hospital, Clichy, France

^p APHP, Department of Intensive Care Medicine, Saint Antoine University Hospital, Paris, France

^q AP-HP.Centre – Université Paris Cité, Medical ICU, Cochin Hospital, Paris, France

^r APHP, Neurological Medical ICU, Pitié Salpétrière Hospital, Paris, France

^s APHP, Medical ICU, Lariboisiere Hospital, Paris, France

^t Multidisciplinary Intensive Care Unit, APHP Paris Saclay University, Antoine Béclère Hospital, Clamart, France; Intensive Care Unit, AP-HP Centre Université Paris Cité, Georges Pompidou European Hospital, 75015, Paris, France

^u APHP, Medical ICU, Pitié Salpétrière Hospital, Paris, France

^v APHP, Department of Anesthesia and Critical Care Medicine, Bichat-Claude Bernard University, France

^w APHP, Department of Intensive Care Medicine, Bicêtre University Hospital, Le Kremlin Bicêtre, France

^x Department of Anesthesiology and Critical Care, Percy Military Training Hospital, Clamart, France

^y Medical ICU, Le Chesnay Hospital, Versailles, France

^z Agence Régionale de Santé Ile-de-France, Paris, France

^aa Sorbonne Université, France

^ab Groupe de Recherche Clinique 29, France

^⁎ Corresponding author.

Abstract

Background

Patients with severe stroke requiring mechanical ventilation have a severe prognosis. There are differences in the management of these patients, particularly regarding intracranial pressure (ICP) monitoring. The aim of this study was to evaluate the association between ICP monitoring and one-year functional outcome of patients with severe stroke in ICU requiring mechanical ventilation.

Materials and methods

We conducted a predefined ancillary study of the SPICE cohort (NCT03335995), comparing patients in ICU with ICP monitoring to those receiving standard monitoring following a stroke requiring mechanical ventilation. The primary outcome was an unfavourable one-year functional outcome, defined by a modified Rankin Scale (mRS) score between 4 and 6. The association between ICP monitoring and functional outcome was evaluated using a multivariate logistic regression and propensity score weighting analyses.

Results

Among the 356 patients in the SPICE cohort, 129 (36%) underwent ICP monitoring (27 ischemic strokes, 50 intracerebral haemorrhages, and 52 subarachnoid haemorrhages). In the ICP group, 71 patients (55%) had an unfavourable functional outcome compared to 168 patients (74%) in the standard monitoring group (Odds Ratio (OR) 0.43 [95%CI, 0.27–0.68]). Patients in the ICP group were younger, had fewer comorbidities, and a less severe clinical presentation. After adjustment for age, Glasgow Coma Scale score, Charlson comorbidity index at admission, septic shock, cerebral oedema, and anisocoria, ICP monitoring was independently associated with lower odds of unfavourable functional outcome (OR 0.38, [95%CI 0.22−0.67]). In the propensity score-weighted analysis, the difference between groups was not statistically significant (OR 0.90 [95%CI, 0.80–1.01]).

Conclusion

ICP monitoring in severe stroke is more commonly employed in younger patients with fewer comorbidities. This monitoring does not appear to be an independent protective factor for a favourable one-year functional outcome when adjusted for confounders.

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Keywords : Intracerebral haemorrhage, Intracranial pressure, Monitoring, Prognosis, Stroke, Subarachnoid haemorrhage