Artikel
Evaluation of a bedside monitoring tool with simultaneous assessment of intracranial pressure, cerebral perfusion pressure, cerebral blood flow and critical closing pressure in patients with severe SAH or brain injury
Evaluation eines simultanen bedside Monitorings von intrakraniellem Druck, zerebralem Perfusionsdruck, zerebralem Blutfluss und kritischem Verschlussdruck bei Hirndruckpatienten
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Autoren
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M. Jägersberg
- Klinik für operative Intensivmedizin, Universitätsklinik Bonn
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J. Boström
- Klinik für Neurochirurgie, Universitätsklinik Bonn
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C. Schaller
- Klinik für Neurochirurgie, Universitätsklinik Bonn
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C. Thees
- Klinik für operative Intensivmedizin, Universitätsklinik Bonn
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Our aim was to analyze the practicability and usefulness of a combined assessment of intracranial pressure (ICP), cerebral perfusion pressure (CPP), cerebral blood flow (CBF) and critical closing pressure (CCP) in a clinical study comparing mannitol vs. HyperHAES® in the efficacy in reducing cerebral edema.
Methods: A consecutive group of n=7 patients suffering from severe SAH or brain injury with intracranial pressure >25 mmHg was treated with mannitol vs. HyperHAES® under bedside monitoring using a combined assessment of CBF, CCP, CPP and ICP. ICP was registered using a intraventricular drainage. Simultaneous synchronized recordings of pressure waveforms of the femoral artery pressure and blood flow velocities of the middle cerebal artery were performed. CCP was calculated from pressure-flow velocity plots by linear extrapolation to zero flow. CBF was registered with a transcerebral double-indicator dilution technique. In addition a hemodynamic monitoring with the PiCCO System® was performed.
Results: We performed 3 measurements per patient, before, 15 and 60 minutes after application of mannitol or HyperHAES® in 7 consecutive patients (4 women, 3 men, aged 20-81 yr, mean age, 49 yr). All patients had diffuse brain edema due to brain injury (4 patients) or SAH (3 patients) with significant, but moderate ICP elevation (>25 mmHg DICP >10 mmHg). 5 Patients were treated with HyperHAES® and 2 patients were treated with mannitol. Our prelimiary results showing the practicability and usefulness of our bedside monitoring setting and the effectiveness of osmotherapy with the new substance HyperHAES® comparing to the gold standard mannitol. An increase of CBF and a decrease of ICP parallel with an increase of hemodynamic parameters could be demonstrated in all treated patients. A total patient number of 40 is planned for reaching significance concerning this part of the study.
Conclusions: We present a simple minimally invasive technique for simultaneous bedside monitoring of ICP, CPP, CBF and CCP in a neurosurgical ICU which may well assist in the management of severe brain edema and might be helpful in drug trials.
