Dynamics of Intracranial Pressure and Cerebrovascular Reactivity During Intrahospital Transportation of Traumatic Brain Injury Patients in Coma.

Autor: Trofimov AO; Department of Neurological Diseases, Privolzhsky Research Medical University, 1 Minin street, Nizhny Novgorod, Russian Federation, 603005. alexeytrofimov1975@gmail.com., Agarkova DI; Department of Neurological Diseases, Privolzhsky Research Medical University, 1 Minin street, Nizhny Novgorod, Russian Federation, 603005., Trofimova KA; Department of Neurological Diseases, Privolzhsky Research Medical University, 1 Minin street, Nizhny Novgorod, Russian Federation, 603005., Atochin DN; Department of Psychiatry, Boston VA Medical Center West Roxbury, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, MA, USA.; Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA., Nemoto EM; Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA., Bragin DE; Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA.; Lovelace Biomedical Research Institute, Albuquerque, NM, USA.
Jazyk: angličtina
Zdroj: Neurocritical care [Neurocrit Care] 2024 Jun; Vol. 40 (3), pp. 1083-1088. Date of Electronic Publication: 2023 Nov 29.
DOI: 10.1007/s12028-023-01882-3
Abstrakt: Background: Intrahospital transportation (IHT) of patients with traumatic brain injury (TBI) is common and may have adverse consequences, incurring inherent risks. The data on the frequency and severity of clinical complications linked with IHT are contradictory, and there is no agreement on whether it is safe or potentially challenging for neurocritical care unit patients. Continuous intracranial pressure (ICP) monitoring is essential in neurointensive care. The role of ICP monitoring and management of cerebral autoregulation impairments in IHT of patients with severe TBI is underinvestigated. The purpose of this nonrandomized retrospective single-center study was to assess the dynamics of ICP and an improved pressure reactivity index (iPRx) as a measure of autoregulation during IHT.
Methods: Seventy-seven men and fourteen women with severe TBI admitted in 2012-2022 with a mean age of 33.2 ± 5.2 years were studied. ICP and arterial pressure were invasively monitored, and cerebral perfusion pressure and iPRx were calculated from the measured parameters. All patients were subjected to dynamic helical computed tomography angiography using a 64-slice scanner Philips Ingenuity computed tomography scan 1-2 days after TBI. Statistical analysis of all results was done using a paired t-test, and p was preset at < 0.05. The logistic regression analysis was performed for cerebral ischemia development dependent on intracranial hypertension and cerebrovascular reactivity.
Results: IHT led to an increase in ICP in all the patients, especially during vertical movement in an elevator (maximum 75.2 mm Hg). During the horizontal transportation on the floor, ICP remained increased (p < 0.05). The mean ICP during IHT was significantly higher (26.1 ± 13.5 mm Hg, p < 0.001) than that before the IHT (19.9 ± 5.3 mm Hg). The mean iPRx after and before IHT was 0.52 ± 0.04 and 0.23 ± 0.14, respectively (p < 0.001).
Conclusions: Both horizontal and vertical transportation causes a significant increase in ICP and iPRx in patients with severe TBI, potentially leading to the outcome worsening.
(© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)
Databáze: MEDLINE
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