Intracranial pressure during hemodialysis in patients with acute brain injury
| Autor: | Kirsten Møller, Ditte Strange, Jørgen Wiis, Mette Brimnes Damholt, Jesper Kelsen, Anton Lund |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Intracranial Pressure Critical Illness medicine.medical_treatment 030232 urology & nephrology Brain Edema Dialysis disequilibrium syndrome Cerebral edema 03 medical and health sciences 0302 clinical medicine Renal Dialysis Interquartile range Internal medicine Humans Urea Medicine Renal replacement therapy Dialysis Aged Retrospective Studies Intracranial pressure integumentary system business.industry Area under the curve General Medicine Middle Aged medicine.disease humanities Renal Replacement Therapy Anesthesiology and Pain Medicine Blood-Brain Barrier Area Under Curve Brain Injuries Acute Disease Cardiology Kidney Failure Chronic Female Hemodialysis business 030217 neurology & neurosurgery |
| Zdroj: | Acta Anaesthesiologica Scandinavica. |
| ISSN: | 1399-6576 0001-5172 |
| Popis: | Background Because osmotic fluid shifts may occur over the blood-brain barrier, patients with acute brain injury are theoretically at risk of surges in intracranial pressure (ICP) during hemodialysis. However, this remains poorly investigated. We studied changes in ICP during hemodialysis in such patients. Methods We performed a retrospective study of patients with acute brain injury admitted to Rigshospitalet (Copenhagen, Denmark) from 2012 to 2016 who received intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT) while undergoing ICP monitoring. Data from each patient's first dialysis session were collected. Area under the curve divided by time (AUC/t) for ICP was calculated separately before and during dialysis. Results Thirteen patients were included. During dialysis, ICP increased from a baseline of 11.9 mm Hg (median; interquartile range 6.3-14.7) to a maximum of 21 mm Hg (18-27) (P = 0.0024), and AUC/t for ICP was greater during dialysis (15.2 (13.4-18.8) vs 11.7 mm Hg (6.4-15.1), P = 0.042). The maximum ICP increase was independent of dialysis modality, but peak values were reached earlier in patients treated with IHD (N = 4) compared to CRRT (N = 9) (75 [30-90] vs 375 min [180-420] after start of treatment, P = 0.0095). The maximum ICP increase correlated positively to the baseline plasma urea concentration (Spearman's r = 0.69, P = 0.017). Conclusion Hemodialysis is associated with increased ICP in neurocritically ill patients, and the magnitude of the increase may be related to initial plasma urea levels. |
| Databáze: | OpenAIRE |
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