Alex Trofimov1,2, George Kalentiev3, Michail Yuriev3, Vladislav Pavlov4, Vera Grigoryeva5. 1. Department of Polytrauma, Regional Hospital named after N.A. Semashko, 190, Rodionov str., Nizhny Novgorod, 603126, Russian Federation. xtro7@mail.ru. 2. Nizhniy Novgorod State Medical Academy, Nizhny Novgorod, Russian Federation. xtro7@mail.ru. 3. Department of Anaesthesiology, Regional Hospital named after N.A. Semashko, 190, Rodionov str., Nizhny Novgorod, Russian Federation. 4. Department of Neurosurgery, Centre Hospitalier Universitaire de Lyon, Lyon, France. 5. Nizhniy Novgorod State Medical Academy, Nizhny Novgorod, Russian Federation.
Abstract
AIM: To assess the dynamic of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and dynamic pressure reactivity index (PRx) during intrahospital transport. MATERIALS AND METHODS: There were 33 comatose patients with severe traumatic brain injury (TBI). The mean age was 36.3 ± 4.8 years (range 19-45 years), and there were 17 men and 16 women. The median Glasgow Coma Scale score at admission was 6.2 ± 0.7. Computed tomography (CT) included native CT, perfusion CT, and CT angiography. RESULTS: The mean CPPs before and after the CT scans were 95.9 ± 10.7 and 81.5 ± 12.5 mmHg respectively. The mean ICP before transport was 19.98 ± 5.3 mmHg (minimum 11.7; maximum 51.7). It was statistically significantly lower (p < 0.001) than during the transfer (26.1 ± 13.5 mmHg). During the period described all patients had increased ICP, especially during vertical movement in an elevator. During horizontal movement on the floor ICP remained higher (p < 0.05). The mean dynamic PRx before and after intrahospital transport was 0.23 ± 0.14 and 0.52 ± 0.04, respectively (p < 0.001). Average duration of the transfer and CT study was 15.3 ± 3.4 min. CONCLUSION: Intrahospital transport of patients with TBI may lead to a significant increase in ICP, dynamic PRx, and decreased CPP. The results suppose that the decision to perform brain CT in comatose patients with TBI should be carefully considered by clinicians.
AIM: To assess the dynamic of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and dynamic pressure reactivity index (PRx) during intrahospital transport. MATERIALS AND METHODS: There were 33 comatosepatients with severe traumatic brain injury (TBI). The mean age was 36.3 ± 4.8 years (range 19-45 years), and there were 17 men and 16 women. The median Glasgow Coma Scale score at admission was 6.2 ± 0.7. Computed tomography (CT) included native CT, perfusion CT, and CT angiography. RESULTS: The mean CPPs before and after the CT scans were 95.9 ± 10.7 and 81.5 ± 12.5 mmHg respectively. The mean ICP before transport was 19.98 ± 5.3 mmHg (minimum 11.7; maximum 51.7). It was statistically significantly lower (p < 0.001) than during the transfer (26.1 ± 13.5 mmHg). During the period described all patients had increased ICP, especially during vertical movement in an elevator. During horizontal movement on the floor ICP remained higher (p < 0.05). The mean dynamic PRx before and after intrahospital transport was 0.23 ± 0.14 and 0.52 ± 0.04, respectively (p < 0.001). Average duration of the transfer and CT study was 15.3 ± 3.4 min. CONCLUSION: Intrahospital transport of patients with TBI may lead to a significant increase in ICP, dynamic PRx, and decreased CPP. The results suppose that the decision to perform brain CT in comatosepatients with TBI should be carefully considered by clinicians.
Entities:
Keywords:
Cerebral perfusion pressure; Head injury; Intracranial pressure; Intrahospital transport
Authors: Jan Küchler; Franziska Tronnier; Emma Smith; Jan Gliemroth; Volker M Tronnier; Claudia Ditz Journal: Neurocrit Care Date: 2019-02 Impact factor: 3.210