Effects of intubation technique on intracranial pressure: a cadaveric study.

Autor: McCormack E; Department of Neurological Surgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, 70112, USA.; Department of Neurological Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA., Aysenne A; Department of Neurological Surgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, 70112, USA., Cardona JJ; Department of Neurological Surgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, 70112, USA. jcardona2@tulane.edu., Chaiyamoon A; Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand., Bui CJ; Department of Neurological Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA., Dumont AS; Department of Neurological Surgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, 70112, USA., Tubbs RS; Department of Neurological Surgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, 70112, USA.; Department of Neurological Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA.; Department of Anatomical Sciences, St. George's University, St. George's, Grenada.; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA.; Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.; University of Queensland, Brisbane, Australia.
Jazyk: angličtina
Zdroj: Neurosurgical review [Neurosurg Rev] 2023 Apr 17; Vol. 46 (1), pp. 88. Date of Electronic Publication: 2023 Apr 17.
DOI: 10.1007/s10143-023-01996-4
Abstrakt: Patients are at risk of increased intracranial pressure (ICP) during manipulation for endotracheal intubation. The aim of this cadaveric study was to quantify this relationship. Five fresh frozen adult cadaveric heads were used. The internal carotid artery (ICA) and internal jugular vein (IJV) were dissected bilaterally. All vessels were occluded on the right side. To mimic central venous pressures, the left IJV was cannulated and filled with water to maintain a pressure of approximately 7 cm H 2 O. The ICA cannula was attached to an oscillating water pump. Next, an ICP monitor was placed. Normophysiological volumes of water were infused to maintain normal ICP. Baseline ICP and IJV pressures were recorded. The heads were then placed in the sniffing position and in neutral position for nasal intubation, and finally an oral endotracheal tube was placed using standard head/neck maneuvers. The ICP was recorded. Mean baseline ICP was 13 mmHg (range 4-18 mmHg) and mean IJV pressure was 6 cm H 2 O. In the sniffing position, ICP increased in all specimens by a mean of 5 mmHg. In the neutral position, after intubation, the ICP increased in all specimens by a mean of 3 mmHg. Nasal intubation resulted in an increase in four of the five specimens. The mean increase in ICP with this maneuver was 2 mmHg. We present a cadaveric model of ICP measurement during neck manipulation using intracranial fluid dynamics. The ICP increased consistently. Following clinical studies, physicians involved in intubating patients with concern for raised ICP should change the technique to avoid complications.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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