gms | German Medical Science

Objective: Bedside percutaneous tracheotomy (PT) is very common for critical ill patients, who require prolonged mechanical ventilation. The effect of the tracheotomy on the intracranial pressure (ICP) is currently subject of debate. Studies with differing results have been published. The aim of our study is to clarify the relation between percutaneous tracheotomy and its effect on intracranial pressure and cerebral perfusion pressure.

Methods: Between December 2010 and October 2011, 34 patients of our intensive care unit were included prospectively into an observational study. Inclusion criteria were the presence of intraparenchymal cerebral pressure measurement (Raumedic, NEUROVENT-P) and the need for percutaneous tracheotomy. Continuous measurement (per minute) of intracranial pressure (ICP), cerebral perfusion pressure (CPP), oxygen saturation (SpO₂), mean arterial pressure (MAP) and heart frequency (HF) started 90 minutes before the procedure, and was continued for another 90 minutes after the end of the procedure. Paired t-test with Bonferroni correction for multiple testing was used. A probability value of p < 0.05 was considered significant.

Results: Percutaneus tracheotomy was performed on 34 patients (f = 16, m = 18; medium = 58 years; 23–76 years). The mean ICP before beginning the intervention was 8 mmHg. Already during the positioning of the patient, the ICP rose up to 15, during the bronchoscopy to 17 and during the tracheotomy to 18 mmHg. All data were significantly higher compared to the baseline level. The development of the mean arterial pressure (MAP) showed a significant increase up to 102 mmHg during tracheotomy. The SpO₂ did not show any significant changes. Mean duration of the procedure was 19, 10 and 17 minutes for positioning, bronchoscopy and tracheotomy.

Conclusions: In this study we performed continuous measurements of MAP and ICP before, during and after percutanous tracheotomy. Our results show, that there is a significant rise of the ICP during percutaneous tracheotomy, while ICP decreases again a few minutes after the procedure. The cerebral perfusion pressure is not compromised significantly due to the accompanying rise of the MAP. From our point of view, tracheotomy should only be performed under constant monitoring of ICP and CPP. In patients with critical phases of brain damages and elevated intracerebral pressure, we suggest performing the tracheotomy at a later point in time.